# COLLIVER SPORTS & SPINE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valley Sports & Spine Clinic, Valley Sports and Spine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447545751
- **Authorized official:** DR. ETHAN B COLLIVER DO (PRESIDENT)
- **Authorized official phone:** (540) 553-4587

## Contact information

- **Practice address:** 120 PROFESSIONAL PARK DR SE STE 7, BLACKSBURG, VA 24060-6739
- **Practice address phone:** (540) 443-3832
- **Practice address fax:** (540) 443-9362
- **Mailing address:** 120 PROFESSIONAL PARK DR SE STE 7, BLACKSBURG, VA 24060-6739
- **Mailing address phone:** (540) 443-3832
- **Mailing address fax:** (540) 443-9362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2011
- **Last updated:** 12/16/2022