Healthcare Provider Details

I. General information

NPI: 1619502853
Provider Name (Legal Business Name): TACTICAL REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 POTOMAC AVE
QUANTICO VA
22134-3458
US

IV. Provider business mailing address

PO BOX 1306
JACKSONVILLE NC
28541-1306
US

V. Phone/Fax

Practice location:
  • Phone: 910-210-0790
  • Fax: 910-210-0791
Mailing address:
  • Phone: 423-262-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KAREN C LYONS
Title or Position: CFO
Credential:
Phone: 423-262-9720