Powerback Rehabilitation LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

POWERBACK REHABILITATION LLC

Practice address

1022 E Wesley Dr
O Fallon, IL 62269-6107

Phone

(618) 607-5081

NPI assigned

Jun 13, 2014

Reactivated

Jun 1, 2017

Organization subpart

No

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

Authorized official

Name

Ian Oppel

Title

Coo

Phone

(980) 254-7007

Specialties & licenses 3

Addresses

Other names 1

• Powerback Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

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

Organizations with this tax ID in the same state 7

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

• Genesis Healthcare

  • Physical Therapy Clinic/Center
  • Chicago, IL
  • NPI 1740604891
  NPD tax ID
• Genesis Rehab Services

  • Assisted Living Facility
  • Champaign, IL
  • NPI 1568806750
  NPD tax ID
• Genesis Rehab Services

  • Physical Disabilities Residential Treatment Facility
  • Chicago, IL
  • NPI 1932453347
  NPD tax ID
• Powerback Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Freeport, IL
  • NPI 1245747393
  NPD tax ID
• Powerback Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Naperville, IL
  • NPI 1396159653
  NPD tax ID
• Powerback Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • O Fallon, IL
  • NPI 1467133231
  NPD tax ID
• Powerback Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Northlake, IL
  • NPI 1598742207
  NPD tax ID

Locations

All facility ownership & control disclosures 25

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

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamee Elizabeth Ahlers, MS-CCC-SLP

  • Speech-Language Pathologist
  • Belleville, IL
  • NPI 1801911144
  Medicare reassignment Care Compare group NPD
• Veronica Ashley Broederdorf, OTR/L

  • Occupational Therapist
  • Chicago, IL
  • NPI 1508257205
  Medicare reassignment Care Compare group NPD
• Andrew Jason Dichsen, OTR/L

  • Occupational Therapist
  • O Fallon, IL
  • NPI 1134836786
  Medicare reassignment Care Compare group NPD
• Mary Elaine Mabayag Fabricante, PT, DPT

  • Physical Therapist
  • Northlake, IL
  • NPI 1972730786
  Medicare reassignment Care Compare group NPD
• Robert Geldert III, OTR/L

  • Occupational Therapist
  • Edwardsville, IL
  • NPI 1881003572
  Medicare reassignment Care Compare group NPD
• Alexandra S Lockridge, D.P.T

  • Physical Therapist
  • Springfield, IL
  • NPI 1124305842
  Medicare reassignment Care Compare group NPD
• Shanie Breann May, CF-SLP

  • Student in an Organized Health Care Education/Training Program
  • Murphysboro, IL
  • NPI 1205627247
  Medicare reassignment Care Compare group NPD
• Andria Moran, CCC-SLP

  • Speech-Language Pathologist
  • Swansea, IL
  • NPI 1043984891
  Medicare reassignment Care Compare group NPD
• Kyle Tanzillo, MOT, OTR/L

  • Occupational Therapist
  • Northlake, IL
  • NPI 1528421187
  Medicare reassignment Care Compare group NPD
• Eric L Wessel, PT

  • Physical Therapist
  • Maryville, IL
  • NPI 1639175086
  Medicare reassignment Care Compare group NPD
• Debra Witt, PT

  • Physical Therapist
  • Blue Island, IL
  • NPI 1881355535
  Medicare reassignment Care Compare group NPD
• Keri A Kreis, PT

  • Physical Therapist
  • Washington, DC
  • NPI 1518987775

  IL

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1982018362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "address_2": "C/O BUSINESS DEVELOPMENT",
            "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": "1022 E WESLEY DR",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622696107",
            "telephone_number": "618-607-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWERBACK REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-13",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "deactivation_date": "2016-04-18",
        "reactivation_date": "2017-06-01",
        "status": "A",
        "authorized_official_last_name": "OPPEL",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "980-254-7007"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powerback Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shayla Porter, RBT
• Jordan Portner
• Caitlin Elizabeth Poths, RBT
• Ryan Sean Potts, B.S RBT
• Powerback Rehabilitation LLC
• Tara McKay Powers
• Carleigh Prane, DMD
• Precision TMS
• Precision TMS
• Bigtyme Price

• Physical Therapist in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.