Healthcare Provider Details

I. General information

NPI: 1780769349
Provider Name (Legal Business Name): CONNALLY OSTEOPATHIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 REDWING RD STE 310
FORT COLLINS CO
80526-2879
US

IV. Provider business mailing address

2629 REDWING RD STE 310
FORT COLLINS CO
80526-2879
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-5479
  • Fax: 970-229-9891
Mailing address:
  • Phone: 970-223-5479
  • Fax: 970-229-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number43258
License Number StateCO

VIII. Authorized Official

Name: PATRICIA A. CONNALLY
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 970-223-5479