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	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790640761
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	:	610-347-4147

Provider Business Practice Location Address
First Line	:	4460 PRINCE WILLIAM PKWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5675
Country	:	US
Telephone Number	:	804-292-0514
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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Directions to “POWERBACK REHABILITATION LLC ” Practice Location

Language	Start Address	Practice Location

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