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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
207RS0010X
Sports Medicine (Internal Medicine) Physician
208000000X
Pediatrics Physician
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Enumeration date
06/15/2011
Last updated
12/16/2022
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