Powerback Rehabilitation LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

POWERBACK REHABILITATION LLC

Doing business as

Powerback Rehabilitation

Practice address

1515 Kingsridge Dr
Oklahoma City, OK 73170-4475

Phone

(405) 676-7274

NPI assigned

Aug 10, 2023

Last updated

Aug 10, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl Anthony Shrom

Title

Ceo

Phone

(215) 896-0422

Specialties & licenses 1

Addresses

Other names 1

• Powerback Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093498610. Details of each certification follow.

• CCN 376637 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 376637

Legal name

POWERBACK REHABILITATION LLC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jul 1, 2024

Last certification

Jul 1, 2024

Ownership / control type

Local Government

Facility address

1515 Kingsridge Dr
Oklahoma City, OK 73170

Tax ID family

Genesis Eldercare Rehab LLC209 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Lawton, OK
  • NPI 1104320233
  NPD tax ID
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Rehabilitation Clinic/Center
  • Norman, OK
  • NPI 1205537156
  NPD tax ID

All facility ownership & control disclosures 25

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1093498610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "800-728-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 KINGSRIDGE DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731704475",
            "telephone_number": "405-676-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWERBACK REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "SHROM",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-896-0422"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powerback Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Latina Powell
• Nathan Daniel Powell, D.D.S.
• Ronald G Powell, MD
• Shanna Powell
• Stacey Powell, LPN
• Powercat Anesthesiology, PLLC
• Cale Eugene Powers, LCSW
• Claire Jane Powers
• Dennis Powers, THERAPIST
• Janet Powers, APRN, NP-C

• Rehabilitation Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Rehabilitation Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.