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General NPI Number Information
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NPI Number | 1780769349
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Entity Type | Organization
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Legal Business Name | CONNALLY OSTEOPATHIC CARE
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2629 REDWING RD STE 310
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City | FORT COLLINS
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State | CO
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Zip | 80526-2879
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Country | US
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Telephone | 970-223-5479
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Fax | 970-229-9891
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Provider Business Mailing Address
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Address Line | 2629 REDWING RD STE 310
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City | FORT COLLINS
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State | CO
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Zip | 80526-2879
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Country | US
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Telephone | 970-223-5479
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Fax | 970-229-9891
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | PATRICIA A. CONNALLY
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Credential | D.O.
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Telephone | 970-223-5479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 43258
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License Number State | CO
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