# POWERBACK REHABILITATION LLC

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

## Provider details

- **NPI number:** 1245747393
- **Authorized official:** CARL ANTHONY SHROM (CEO)
- **Authorized official phone:** (215) 896-0422

## Contact information

- **Practice address:** 1234 S PARK BLVD, FREEPORT, IL 61032-4602
- **Practice address phone:** (815) 616-5952
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (610) 925-4560
- **Mailing address fax:** (610) 347-4147

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/10/2018
- **Last updated:** 02/27/2023