Provider Demographics
NPI:1821411752
Name:ABSOLUTELY THIN
Entity Type:Organization
Organization Name:ABSOLUTELY THIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-934-3231
Mailing Address - Street 1:15150 PRESTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4877
Mailing Address - Country:US
Mailing Address - Phone:972-934-3231
Mailing Address - Fax:
Practice Address - Street 1:15150 PRESTON RD SUITE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248
Practice Address - Country:US
Practice Address - Phone:972-934-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02139132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty