Provider Demographics
NPI:1780769349
Name:CONNALLY OSTEOPATHIC CARE
Entity type:Organization
Organization Name:CONNALLY OSTEOPATHIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-223-5479
Mailing Address - Street 1:2629 REDWING RD STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2879
Mailing Address - Country:US
Mailing Address - Phone:970-223-5479
Mailing Address - Fax:970-229-9891
Practice Address - Street 1:2629 REDWING RD STE 310
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2879
Practice Address - Country:US
Practice Address - Phone:970-223-5479
Practice Address - Fax:970-229-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43258207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty