| Organization Name: | TACKLE MANAGEMENT CORPORATION |
| NPI Number: | 1033399688 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA LYNN COATES (PRACTICE ADMINISTRATOR) |
| Mailing Address: | 8637 Mathis Ave Manassas |
| State: | VA US |
| Postal Code: | 201105270 |
| Phone Number: | 7033356890 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2007 |
| NPI Last Update Date: | 11/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |