=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962001123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TACTICAL REHABILITATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2020
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1891 HWY 40 E STE 1108
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31548-6573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-420-7365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 C LYONS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-262-9720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------