MEDICARE: POWERBACK REHABILITATION LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist
4	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1083025936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWERBACK REHABILITATION LLC

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 LAKE ST
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-7752
Country	:	US
Telephone Number	:	570-674-6954
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	IAN OPPEL
Credential	:
Telephone Number	:	980-254-7007

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	02/06/2026

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