Healthcare Provider Details

I. General information

NPI: 1255260568
Provider Name (Legal Business Name): TACTICAL REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 NW CACHE RD
LAWTON OK
73505-3415
US

IV. Provider business mailing address

2040 WILMINGTON HWY STE A
JACKSONVILLE NC
28540-3191
US

V. Phone/Fax

Practice location:
  • Phone: 405-253-5127
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL

VIII. Authorized Official

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