Provider Demographics
NPI:1902962459
Name:COLON ME CLEAN
Entity Type:Organization
Organization Name:COLON ME CLEAN
Other - Org Name:YVONNE H. THOMAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COLON HYDROTHERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:817-366-0485
Mailing Address - Street 1:2236 E LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4013
Mailing Address - Country:US
Mailing Address - Phone:817-451-0911
Mailing Address - Fax:817-451-0911
Practice Address - Street 1:2236 E LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4013
Practice Address - Country:US
Practice Address - Phone:817-451-0911
Practice Address - Fax:817-451-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32695 16175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty