Individual ProviderNicholas MetaxasPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address22 Masonic Ave, Wallingford, CT 06492-3048(203) 641-9684PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Metaxas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1841805397Provider TypeIndividualFull NameMetaxas, NicholasTitleDr.CredentialPT, DPTGenderMaleSole ProprietorNoEnumeration Date9/11/2020Last Updated9/11/2020Contact InformationPractice LocationPractice Address22 Masonic Ave, Wallingford, CT 06492-3048Phone(203) 641-9684FaxUnlisted FaxMailing LocationMailing Address50 Kim Ln, Meriden, CT 06450-6927Phone(203) 641-9684FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense12790Connecticut