53D2166936 CLIA NUMBER - ROCKY MOUNTAIN PM&R

Laboratory Demographics

  • CLIA Code: 53D2166936
  • Facility Name: ROCKY MOUNTAIN PM&R
  • Facility Address: 5880 ENTERPRISE DRIVE, SUITE 400
    CASPER, WY
    ZIP 82609
  • Facility Phone: (307) 333-6567
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARLOS BUCKNER
  • NPI Number: 1679851570
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 53D2166936
LAB Type Physician Office
Facility Name ROCKY MOUNTAIN PM&R
Street 5880 ENTERPRISE DRIVE, SUITE 400
City CASPER
State WY
ZIP 82609
Phone 3073336567
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director CARLOS BUCKNER

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