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NPI Code Detail

MEDICARE: POWERBACK REHABILITATION LLC

MEDICARE: POWERBACK REHABILITATION 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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1265858781
Entity Type Code : Organization
Provider Name (Legal Business Name) : POWERBACK REHABILITATION LLC
Provider Business Mailing Address
First Line : 101 E STATE ST
Second Line : C/O AMY NUNEMAKER
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number : 610-925-4560
Fax Number :
Provider Business Practice Location Address
First Line : 815 ATLANTA RD
Second Line :
City : CUMMING
State : GA
Zip : 30040-2707
Country : US
Telephone Number : 678-947-0952
Fax Number :
Authorized Official
Title or Position : CEO
Name : CARL ANTHONY SHROM
Credential :
Telephone Number : 215-896-0422
Provider Enumeration Date : 03/07/2014
Last Update Date : 02/27/2023

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Directions to “POWERBACK REHABILITATION LLC ” Practice Location

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