Grayson Wickham
Physical Therapist in New York, NY. Individual provider (NPI-1).
NPI number1003285693
StatusActive
Last updated in NPPESSep 24, 2015
Details
- NPI
- 1003285693
- Entity type
- Individual (NPI-1)
- Name
- Grayson Wickham
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 24, 2015
- Last updated
- Sep 24, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 039473 | NY | Yes |
Practice location
667 Madison AveNew York, NY 10065-8029
Phone 877-474-5280
Mailing address
2102 81st StEast Elmhurst, NY 11370-1321
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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