Healthcare Provider Details

I. General information

NPI: 1932135563
Provider Name (Legal Business Name): DERRY SPORTS & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DANVILLE RD
EAST HAMPSTEAD NH
03826
US

IV. Provider business mailing address

55 BRIDGE ST
MANCHESTER NH
03101-1603
US

V. Phone/Fax

Practice location:
  • Phone: 603-382-0019
  • Fax: 603-382-1105
Mailing address:
  • Phone: 603-232-4513
  • Fax: 603-782-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS VAILAS
Title or Position: OWNER
Credential:
Phone: 603-232-4513