Colliver, Ethan B
Colliver, Ethan B is an individual health care provider with primary practice located at 120 Professional Park Dr Se Ste 7 , Blacksburg VA 24060. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Colliver, Ethan B can be contacted via phone (540) 443-3832.Contact Information
Primary practice address
120 Professional Park Dr Se Ste 7
Blacksburg VA 24060
Phone: (540) 443-3832
Fax: (540) 443-9362
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 0102202357 | Virginia |
Profile Details
| NPI number | 1184803330 |
|---|---|
| LBN Legal business name | Colliver, Ethan B |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 24th, 2007 |
| Last updated | Dec 16th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184803330 | NPPES |
| Virginia | MEDICAID | 1184803330 |
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