=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740718139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TACTICAL REHABILITATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2017
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 E VIRGINIA BEACH BLVD STE 21
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-2499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-785-5873
-----------------------------------------------------
Fax | 772-257-5241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2040 WILMINGTON HWY STE A
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-3191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-262-9720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | KAREN LYONS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-262-9720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------