NPIMap

Organization Active NPI

Derry Sports & Rehab LLC

  • Physical Therapist
  • Salem, NH
National Provider Identifier
1023212198
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DERRY SPORTS & REHAB LLC
Doing business as
Salem Sports & Rehab
Practice address
159 N Broadway
Salem, NH 03079
Phone
(603) 898-9947
Fax
(603) 898-9949
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicholas Vailas
Title
Owner
Phone
(603) 232-4513

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

159 N Broadway
Salem, NH 03079

Mailing address

55 Bridge St
Manchester, NH 03101-1603
Phone (603) 232-4513

Other identifiers 1

IdentifierTypeStateIssuer
1487670386OtherNHNPI

Other names 1

  • Salem Sports & Rehab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180619001012 NH Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052666807 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Derry, NH; Salem, NH; East Hampstead, NH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Derry Sports and Rehab3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

159 N Broadway
Ste 2A
Salem, NH 03079
Phone (603) 644-5900

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1023212198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BRIDGE ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011603",
            "telephone_number": "603-232-4513",
            "fax_number": "603-782-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 N BROADWAY",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "03079",
            "telephone_number": "603-898-9947",
            "fax_number": "603-898-9949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY SPORTS & REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "VAILAS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-232-4513"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487670386",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salem Sports & Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salem Sports & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.