Healthcare Provider Details

I. General information

NPI: 1124975438
Provider Name (Legal Business Name): TACTICAL REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CROSSING BLVD
ORANGE PARK FL
32073-6204
US

IV. Provider business mailing address

2040 WILMINGTON HWY STE A
JACKSONVILLE NC
28540-3191
US

V. Phone/Fax

Practice location:
  • Phone: 757-879-2398
  • Fax:
Mailing address:
  • Phone: 423-278-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. OSCAR MULLINAX JR.
Title or Position: CORPORATE COMPLIANCE OFFICER
Credential:
Phone: 423-278-9023