Organization
POWERBACK REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL ANTHONY SHROM (CEO)
(215) 896-0422
Entity
Organization
Contact information
Practice address
401 W LAKE ST, NORTHLAKE, IL 60164-2435
(708) 384-8073
Mailing address
101 E STATE ST, C/O AMY NUNEMAKER, KENNETT SQUARE, PA 19348-3109
(610) 925-4560
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/23/2005
Last updated
02/27/2023
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