15D2291604 CLIA NUMBER - FAST PACE MEDICAL CLINIC PLLC

Laboratory Demographics

  • CLIA Code: 15D2291604
  • Facility Name: FAST PACE MEDICAL CLINIC PLLC
  • Facility Address: 1320 WEST STATE ROAD 2
    LA PORTE, IN
    ZIP 46350
  • Facility Phone: (931) 253-1110
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SELENA GURLEY
  • NPI Number: 1073014643
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 15D2291604
LAB Type Practitioner Other
Facility Name FAST PACE MEDICAL CLINIC PLLC
Street 1320 WEST STATE ROAD 2
City LA PORTE
State IN
ZIP 46350
Phone 9312531110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Practitioner Other
Lab Director SELENA GURLEY

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This page was last updated on: 5/18/2026