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
1	261Q00000X	Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1295306116
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	:	800-728-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	9700 PENSACOLA BLVD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-1242
Country	:	US
Telephone Number	:	800-728-8808
Fax Number	:

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	05/21/2026

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