Grayson Wickham
Physical Therapist
667 Madison Ave
New York
, New York 10065-8029
Grayson Wickham
Physical Therapist
667 Madison Ave
New York
, New York 10065-8029
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About
Features
Specialties
- Physical Therapist
Languages spoken
- English
Location
First Address
- Grayson Wickham
- 2102 81st St
- East Elmhurst, NY
- Zip : 11370-1321
- Phone :
Second Address
- Grayson Wickham
- 667 Madison Ave
- New York, NY
- Zip : 10065-8029
- Phone : (877) 474-5280
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 039473 | NY |
National Provider Identifier
| NPI | 1003285693 |
|---|---|
| Provider Name | Grayson Wickham |
| First Address | East Elmhurst, NY 11370-1321 |
| Second Address | New York, NY 10065-8029 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/09/2015 |
| Last Update Date | 24/09/2015 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.