Individual ProviderGeorge WakehamPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address3391 Richmond Ave, Staten Island, NY 10312-2025(718) 608-9170(347) 302-8715PECOS EnrollmentBased on the most recent information from CMS, provider George Wakeham 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 34 days ago.Profile DetailsProvider ID1861919243Provider TypeIndividualFull NameWakeham, GeorgeTitleDr.GenderMaleSole ProprietorNoEnumeration Date8/25/2017Last Updated8/28/2017Contact InformationPractice LocationPractice Address3391 Richmond Ave, Staten Island, NY 10312-2025Phone(718) 608-9170FaxUnlisted FaxMailing LocationMailing Address165 Lathrop Ave, Staten Island, NY 10314-2275Phone(347) 302-8715FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense024103New York