MEDICARE: WSSH POWERBACK REHABILITATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1124952973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSSH POWERBACK REHABILITATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	9526 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9255 US HIGHWAY 42
Second Line	:
City	:	UNION
State	:	KY
Zip	:	41091-7198
Country	:	US
Telephone Number	:	323-928-9445
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	AVROHOM TRESS
Credential	:
Telephone Number	:	323-928-9445

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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