Provider Demographics
NPI:1669797239
Name:OPTIMA SPORTS THERAPY & REHABILITATION
Entity type:Organization
Organization Name:OPTIMA SPORTS THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHSIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-898-2244
Mailing Address - Street 1:16 PELHAM RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2826
Mailing Address - Country:US
Mailing Address - Phone:603-894-1111
Mailing Address - Fax:603-894-1113
Practice Address - Street 1:16 PELHAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2826
Practice Address - Country:US
Practice Address - Phone:603-894-1111
Practice Address - Fax:603-894-1113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSEX ORTHOPAEDICS & OPTIMA SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0004183Medicare PIN