Healthcare Provider Details

I. General information

NPI: 1164369435
Provider Name (Legal Business Name): ROOTED STRENGTH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 OAKLAND MILLS RD STE M
COLUMBIA MD
21046-1570
US

IV. Provider business mailing address

7250 PRESERVATION CT
FULTON MD
20759-2304
US

V. Phone/Fax

Practice location:
  • Phone: 443-875-5960
  • Fax:
Mailing address:
  • Phone: 443-875-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYDIA ELIZABETH PAVELKA
Title or Position: OWNER
Credential: DPT
Phone: 443-875-5960