Healthcare Provider Details

I. General information

NPI: 1568869766
Provider Name (Legal Business Name): TACTICAL REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 WILMINGTON HWY SUITE 3
JACKSONVILLE NC
28540-3121
US

IV. Provider business mailing address

86 43RD CT
VERO BEACH FL
32968-2372
US

V. Phone/Fax

Practice location:
  • Phone: 910-333-0396
  • Fax: 910-238-2741
Mailing address:
  • Phone: 858-254-7395
  • Fax: 772-978-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN C LYONS
Title or Position: CFO/CLO
Credential:
Phone: 423-262-9722