Healthcare Provider Details

I. General information

NPI: 1083528814
Provider Name (Legal Business Name): NORTHERN COLORADO SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3726 S TIMBERLINE RD STE 102
FORT COLLINS CO
80525-4332
US

IV. Provider business mailing address

3726 S TIMBERLINE RD STE 102
FORT COLLINS CO
80525-4332
US

V. Phone/Fax

Practice location:
  • Phone: 443-370-9655
  • Fax:
Mailing address:
  • Phone: 443-370-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZACHARY DEVILBISS
Title or Position: PHYSICIAN
Credential: DO
Phone: 443-370-9655