NPIMap

Organization Active NPI

Derry Sports & Rehab, LLC

  • Physical Therapist
  • Derry, NH
National Provider Identifier
1487670386
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
Practice address
23A Crystal Ave
Derry, NH 03038-2415
Phone
(603) 437-3338
Fax
(603) 437-3255
NPI assigned
Jul 14, 2006
Last updated
Jul 17, 2025By the provider in NPPES
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 Therapist 225100000X NH Primary
Occupational Therapist 225X00000X NH

Addresses

Primary practice location

23A Crystal Ave
Derry, NH 03038-2415

Mailing address

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

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
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

11 Manchester Rd
Unit 1
Derry, NH 03038
Phone (603) 437-3338

23 Crystal Ave
Unit 2
Derry, NH 03038
Phone (603) 437-3338

700 Lake Ave
Ste 2
Manchester, NH 03103
Phone (603) 621-0681

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1487670386",
    "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": "23A CRYSTAL AVE",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382415",
            "telephone_number": "603-437-3338",
            "fax_number": "603-437-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY SPORTS & REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "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": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derry, 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.