Healthcare Provider Details

I. General information

NPI: 1831379973
Provider Name (Legal Business Name): OPTIMA SPORTS THERAPY & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PELHAM RD
SALEM NH
03079-2826
US

IV. Provider business mailing address

16 PELHAM RD
SALEM NH
03079-2826
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-2244
  • Fax: 603-898-2227
Mailing address:
  • Phone: 603-898-2244
  • Fax: 603-898-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAHSIN M ERGIN
Title or Position: MEMBER
Credential: M.D.
Phone: 603-898-2244