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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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3261QR0400XRehabilitation Clinic/Center
4225100000XPhysical Therapist

General Provider Information

NPI Number : 1427454164
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 : 7801 N RICHLAND BLVD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-6415
Country : US
Telephone Number : 469-609-9044
Fax Number :
Authorized Official
Title or Position : CEO
Name : CARL ANTHONY SHROM
Credential :
Telephone Number : 215-896-0422
Provider Enumeration Date : 11/07/2014
Last Update Date : 02/24/2023

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Directions to “POWERBACK REHABILITATION LLC ” Practice Location

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