03D2108472 CLIA NUMBER - LIFEQUEST PHYSICAL MEDICINE AND REHAB

Laboratory Demographics

  • CLIA Code: 03D2108472
  • Facility Name: LIFEQUEST PHYSICAL MEDICINE AND REHAB
  • Facility Address: 1050 E RAY RD, STE 4A
    CHANDLER, AZ
    ZIP 85225
  • Facility Phone: 480 659-2000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CASSANDRA DORAME
  • NPI Number: 1255946075
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 03D2108472
LAB Type Physician Office
Facility Name LIFEQUEST PHYSICAL MEDICINE AND REHAB
Street 1050 E RAY RD, STE 4A
City CHANDLER
State AZ
ZIP 85225
Phone 480 659-2000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2024
Certificate Expiration Date 2/4/2026
Facility Type Physician Office
Lab Director CASSANDRA DORAME

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This page was last updated on: 9/29/2025