49D2311687 CLIA NUMBER - REVIVE CLINIC & IV THERAPY

Laboratory Demographics

  • CLIA Code: 49D2311687
  • Facility Name: REVIVE CLINIC & IV THERAPY
  • Facility Address: 7000 INFANTRY RIDGE RD SUITE 110
    MANASSAS, VA
    ZIP 20109
  • Facility Phone: 703 828-8089
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KYANA ANTHONY
  • NPI Number: 1942079231
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 49D2311687
LAB Type Physician Office
Facility Name REVIVE CLINIC & IV THERAPY
Street 7000 INFANTRY RIDGE RD SUITE 110
City MANASSAS
State VA
ZIP 20109
Phone 703 828-8089
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director KYANA ANTHONY

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This page was last updated on: 6/4/2025