Provider Demographics
NPI:1457089369
Name:TACTICAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:TACTICAL REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-262-9720
Mailing Address - Street 1:2040 WILMINGTON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3191
Mailing Address - Country:US
Mailing Address - Phone:423-262-9720
Mailing Address - Fax:
Practice Address - Street 1:425 N ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:SD
Practice Address - Zip Code:57719-2026
Practice Address - Country:US
Practice Address - Phone:423-262-9720
Practice Address - Fax:910-210-0791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TACTICAL REHABILITATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies