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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
1235Z00000XSpeech-Language Pathologist
2225100000XPhysical Therapist
3225X00000XOccupational Therapist
4261QR0400XRehabilitation Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851378566
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 : 4730 ATRIUM CT
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-3556
Country : US
Telephone Number : 410-363-4790
Fax Number :
Authorized Official
Title or Position : CEO
Name : CARL ANTHONY SHROM
Credential :
Telephone Number : 215-896-0422
Provider Enumeration Date : 12/23/2005
Last Update Date : 02/27/2023

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Directions to “POWERBACK REHABILITATION LLC ” Practice Location

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