MEDICARE: 2 EVOLVE COLONIC & WELLNESS SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1184563082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2 EVOLVE COLONIC & WELLNESS SERVICES LLC

Provider Business Mailing Address
First Line	:	6111 FM 1960 RD W STE 109B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4108
Country	:	US
Telephone Number	:	281-732-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 FM 1960 RD W STE 109B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4108
Country	:	US
Telephone Number	:	281-732-9367
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA YUVETTE RODGERS
Credential	:
Telephone Number	:	281-732-9367

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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