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Organization
COLLIVER SPORTS & SPINE INC
Active
Organization
COLLIVER SPORTS & SPINE INC
Active
Other names
Valley Sports & Spine Clinic, Valley Sports and Spine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN B COLLIVER DO (PRESIDENT)
(540) 553-4587
Entity
Organization
Contact information
Practice address
120 PROFESSIONAL PARK DR SE STE 7, BLACKSBURG, VA 24060-6739
(540) 443-3832
(540) 443-9362
Mailing address
120 PROFESSIONAL PARK DR SE STE 7, BLACKSBURG, VA 24060-6739
(540) 443-3832
(540) 443-9362
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
NULL
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
06/15/2011
Last updated
12/16/2022
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