Provider Demographics
NPI:1023212198
Name:DERRY SPORTS & REHAB LLC
Entity Type:Organization
Organization Name:DERRY SPORTS & REHAB LLC
Other - Org Name:SALEM SPORTS & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARANASIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-566-2447
Mailing Address - Street 1:700 LAKE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2734
Mailing Address - Country:US
Mailing Address - Phone:603-232-4513
Mailing Address - Fax:
Practice Address - Street 1:159 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-898-9947
Practice Address - Fax:603-898-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1487670386OtherNPI