Healthcare Provider Details

I. General information

NPI: 1295117232
Provider Name (Legal Business Name): POWERBACK REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OUT LOOK DR C/O BROADMORE AL AT TEAYS VALLEY
HURRICANE WV
25526-9467
US

IV. Provider business mailing address

101 E STATE ST C/O AMY NUNEMAKER
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-1517
  • Fax:
Mailing address:
  • Phone: 610-925-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IAN OPPEL
Title or Position: COO
Credential:
Phone: 980-254-7007