MEDICARE: CONNALLY OSTEOPATHIC CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0010X	Sports Medicine (Internal Medicine) Physician	43258	CO

General Provider Information

NPI Number	:	1780769349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNALLY OSTEOPATHIC CARE

Provider Business Mailing Address
First Line	:	2629 REDWING RD STE 310
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2879
Country	:	US
Telephone Number	:	970-223-5479
Fax Number	:	970-229-9891

Provider Business Practice Location Address
First Line	:	2629 REDWING RD STE 310
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2879
Country	:	US
Telephone Number	:	970-223-5479
Fax Number	:	970-229-9891

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	PATRICIA A. CONNALLY
Credential	:	D.O.
Telephone Number	:	970-223-5479

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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