Provider Demographics
NPI:1194201327
Name:TACTICAL REHABILITATION INC
Entity Type:Organization
Organization Name:TACTICAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:858-254-7395
Mailing Address - Street 1:86 43RD CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-2372
Mailing Address - Country:US
Mailing Address - Phone:858-254-7395
Mailing Address - Fax:772-978-0110
Practice Address - Street 1:1911 N NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78208-1419
Practice Address - Country:US
Practice Address - Phone:910-210-0790
Practice Address - Fax:910-210-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002180OtherDEVICE DISTRIBUTOR LICENSE