Colliver Sports & Spine Inc

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

COLLIVER SPORTS & SPINE INC

Practice address

120 Professional Park Dr SE Ste 7
Blacksburg, VA 24060-6739

Phone

(540) 443-3832

Fax

(540) 443-9362

NPI assigned

Jun 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ethan B Colliver, DO

Title

President

Phone

(540) 553-4587

Specialties & licenses 4

Addresses

Other names 2

• Valley Sports & Spine Clinic Doing business as
• Valley Sports and Spine Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1447545751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PROFESSIONAL PARK DR SE STE 7",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606739",
            "telephone_number": "540-443-3832",
            "fax_number": "540-443-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PROFESSIONAL PARK DR SE STE 7",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606739",
            "telephone_number": "540-443-3832",
            "fax_number": "540-443-9362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIVER SPORTS & SPINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "COLLIVER",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-553-4587",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Sports & Spine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Sports and Spine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristina Faye Collette, PT, DPT
• Amy Moore Collins, RPH
• Ann Shaw Collins, DO
• Sara Moriah Collins, COTA/L
• Sean Collins
• Lacey Colvin, D.O.
• Elisabeth G. Combs, DMD
• Commonwealth Hospitalist Group, LLC
• Bettina Comparativo
• Joseph Howard Conduff III, MD

• Physical Medicine & Rehabilitation Physician in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Physical Medicine & Rehabilitation Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.