Provider Demographics
NPI:1821961087
Name:UNEVEN LOTUS YOGA, LLC
Entity type:Organization
Organization Name:UNEVEN LOTUS YOGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED YOGA TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:ERYT200, YACEP
Authorized Official - Phone:616-805-9195
Mailing Address - Street 1:5935 CRESTMOOR DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6511
Mailing Address - Country:US
Mailing Address - Phone:616-805-9195
Mailing Address - Fax:
Practice Address - Street 1:5935 CRESTMOOR DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6511
Practice Address - Country:US
Practice Address - Phone:616-805-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty