# POWERBACK REHABILITATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Powerback Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184205056
- **Authorized official:** CARL ANTHONY SHROM (CEO)
- **Authorized official phone:** (215) 896-0422

## Contact information

- **Practice address:** 3500 12TH ST, TILLAMOOK, OR 97141-2637
- **Practice address phone:** (971) 354-4267
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (800) 728-8808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 04/21/2021
- **Last updated:** 03/31/2023