Provider Demographics
NPI:1962001123
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:
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:
Practice Address - Street 1:6331 ROOSEVELT BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3308
Practice Address - Country:US
Practice Address - Phone:858-254-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TACTICAL REHABILITATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier