Healthcare Provider Details

I. General information

NPI: 1609368174
Provider Name (Legal Business Name): INTEGRATIVE SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S COLLEGE AVE
FORT COLLINS CO
80525-1464
US

IV. Provider business mailing address

2020 S COLLEGE AVE
FORT COLLINS CO
80525-1464
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-1668
  • Fax:
Mailing address:
  • Phone: 970-825-6825
  • Fax: 855-298-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRAD SETH ABRAHAMSON
Title or Position: MEMBER OWNER
Credential: MD
Phone: 970-691-3847