08D2115575 CLIA NUMBER - DELAWARE BACK PAIN & SPORTS REHAB CENTERS

Laboratory Demographics

CLIA Number: 08D2115575

Facility Name: DELAWARE BACK PAIN & SPORTS REHAB CENTERS

Facility Address:
124 SLEEPY HOLLOW ROAD, SUITE 204
MIDDLETOWN, DE
ZIP 19709
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Facility Phone Number: 302 832-3369

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568032027

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	08D2115575
LAB Type	Physician Office
Facility Name	DELAWARE BACK PAIN & SPORTS REHAB CENTERS
Street	124 SLEEPY HOLLOW ROAD, SUITE 204
City	MIDDLETOWN
State	DE
ZIP	19709
Phone	302 832-3369
CertificateType	4
CertificateEffectiveDate	7/11/2022
CertificateExpirationDate	7/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024