Ethan B. Colliver D.O. PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

0102202537 Issued in VA

Legal business name

ETHAN B. COLLIVER D.O. PLLC

Doing business as

Colliver Sports and Spine Clinic

Practice address

3706 S Main St
Blacksburg, VA 24060-7006

Phone

(540) 345-3556

Fax

(540) 777-1147

NPI assigned

May 3, 2011

Organization subpart

No

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

Authorized official

Name

Ethan B. Colliver, D.O.

Title

President

Phone

(540) 345-3556

Specialties & licenses 1

Addresses

Other names 1

• Colliver Sports and Spine Clinic Doing business as

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1740572205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8310",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240140310",
            "telephone_number": "540-345-3556",
            "fax_number": "540-777-1147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3706 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607006",
            "telephone_number": "540-345-3556",
            "fax_number": "540-777-1147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN B. COLLIVER D.O. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "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": "540-345-3556",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0102202537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colliver Sports and Spine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 May 3, 2011; 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.