10D2236530 CLIA NUMBER - DNA COMPREHENSIVE THERAPY SERVICES LLC

Laboratory Demographics

CLIA Number: 10D2236530

Facility Name: DNA COMPREHENSIVE THERAPY SERVICES LLC

Facility Address:
11349 CORTEZ BLVD
BROOKSVILLE, FL
ZIP 34613
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Facility Phone Number: 239 236-8784

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720752041

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2236530
LAB Type	Physician Office
Facility Name	DNA COMPREHENSIVE THERAPY SERVICES LLC
Street	11349 CORTEZ BLVD
City	BROOKSVILLE
State	FL
ZIP	34613
Phone	239 236-8784
CertificateType	4
CertificateEffectiveDate	9/17/2023
CertificateExpirationDate	9/16/2025
FacilityType	Waiver

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