Colliver Sports & Spine INC
Physical Medicine & Rehabilitation in Blacksburg, VA. Organization (NPI-2).
NPI number1447545751
StatusActive
Last updated in NPPESDec 16, 2022
Details
- NPI
- 1447545751
- Entity type
- Organization (NPI-2)
- Legal business name
- Colliver Sports & Spine INC
- Organization subpart
- No
- Enumeration date
- Jun 15, 2011
- Certification date
- Dec 16, 2022
- Last updated
- Dec 16, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | – | – | Yes |
| 207R00000X | Internal Medicine | – | – | |
| 207RS0010X | Internal Medicine, Sports Medicine | – | – | |
| 208000000X | Pediatrics | – | – |
Other names
- Valley Sports & Spine Clinic (Doing Business As)
- Valley Sports And Spine Clinic (Doing Business As)
Practice location
120 Professional Park Dr Se Ste 7Blacksburg, VA 24060-6739
Phone 540-443-3832 · Fax 540-443-9362
Mailing address
120 Professional Park Dr Se Ste 7Blacksburg, VA 24060-6739
Phone 540-443-3832 · Fax 540-443-9362
Authorized official
Ethan B Colliver
President
5405534587
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