03D2128471 CLIA NUMBER - ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER

Laboratory Demographics

  • CLIA Code: 03D2128471
  • Facility Name: ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER
  • Facility Address: 15547 N REEMS RD, BLDG A
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 535-9777
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WENDI J. LUNDQUIST
  • NPI Number: 1811130016
  • Taxonomy: 2081P2900X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 03D2128471
LAB Type Physician Office
Facility Name ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER
Street 15547 N REEMS RD, BLDG A
City SURPRISE
State AZ
ZIP 85374
Phone 623 535-9777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Physician Office
Lab Director WENDI J. LUNDQUIST

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This page was last updated on: 3/20/2025