Provider Demographics
NPI:1417149642
Name:GERDOMY, LLC
Entity Type:Organization
Organization Name:GERDOMY, LLC
Other - Org Name:KEENE PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-355-1578
Mailing Address - Street 1:216 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4162
Mailing Address - Country:US
Mailing Address - Phone:603-355-1578
Mailing Address - Fax:
Practice Address - Street 1:216 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4162
Practice Address - Country:US
Practice Address - Phone:603-355-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2997261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy