Powerback Rehabilitation LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

POWERBACK REHABILITATION LLC

Doing business as

Powerback Rehabilitation

Practice address

1000 S Maplewood Dr
C/O Emeritus at Maplewood
Bridgeport, WV 26330-9593

Phone

(304) 933-3338

NPI assigned

Jul 1, 2015

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 WV

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 516533

Legal name

POWERBACK REHABILITATION

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jul 12, 2016

Last certification

May 9, 2022

Ownership / control type

Proprietary

Facility address

1000 S Maplewood Drive
Bridgeport, WV 26330

Tax ID family

Genesis Rehab Serv209 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 5

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

  • Rehabilitation Clinic/Center
  • Hurricane, WV
  • NPI 1295117232
  NPD tax ID
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Ona, WV
  • NPI 1336858398
  NPD tax ID
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Rehabilitation Clinic/Center
  • Martinsburg, WV
  • NPI 1407447790
  NPD tax ID
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Rehabilitation Clinic/Center
  • Huntington, WV
  • NPI 1649652694
  NPD tax ID
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Rehabilitation Clinic/Center
  • Beaver, WV
  • NPI 1811379860
  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": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1336522929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "address_2": "C/O AMY NUNEMAKER",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "610-925-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S MAPLEWOOD DR",
            "address_2": "C/O EMERITUS AT MAPLEWOOD",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309593",
            "telephone_number": "304-933-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWERBACK REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "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"
        }
    ]
}

• Ronald D Porter, CRNA
• Hallina Nicole Portner, OD
• Jason D Posey, PT
• Cassandra Nicole Poster, APRN
• Laura E Potesta, PAC
• Andrew Powers
• Premier Medical Group, Inc.
• Premier Pediatrics PLLC
• Prescription Shop LLC (The Prescription Shop LLC)
• Jessica Lynn Pritt, APRN, FNP-BC

• Rehabilitation Clinic/Center in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Rehabilitation Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.