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General NPI Number Information
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NPI Number | 1932135563
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Entity Type | Organization
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Legal Business Name | DERRY SPORTS & REHAB, LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 45 DANVILLE RD
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City | EAST HAMPSTEAD
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State | NH
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Zip | 03826
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Country | US
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Telephone | 603-382-0019
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Fax | 603-382-1105
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Provider Business Mailing Address
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Address Line | 55 BRIDGE ST
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City | MANCHESTER
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State | NH
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Zip | 03101-1603
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Country | US
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Telephone | 603-232-4513
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Fax | 603-782-5123
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS VAILAS
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Credential |
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Telephone | 603-232-4513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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