Healthcare Provider Details

I. General information

NPI: 1326959750
Provider Name (Legal Business Name): THERESA LYNN FILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BOARDWALK DR STE 490
FORT COLLINS CO
80525-3040
US

IV. Provider business mailing address

155 BOARDWALK DR STE 490
FORT COLLINS CO
80525-3040
US

V. Phone/Fax

Practice location:
  • Phone: 888-365-8850
  • Fax: 303-616-1189
Mailing address:
  • Phone: 888-365-8850
  • Fax: 303-616-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: