Provider Demographics
NPI:1487670386
Name:DERRY SPORTS & REHAB, LLC
Entity type:Organization
Organization Name:DERRY SPORTS & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSTERGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-506-6833
Mailing Address - Street 1:55 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1603
Mailing Address - Country:US
Mailing Address - Phone:603-232-4513
Mailing Address - Fax:603-782-5123
Practice Address - Street 1:23A CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2415
Practice Address - Country:US
Practice Address - Phone:603-437-3338
Practice Address - Fax:603-437-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty