Healthcare Provider Details

I. General information

NPI: 1255369930
Provider Name (Legal Business Name): ALIZA STACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 ROUTE 9
HALFMOON NY
12065-2402
US

IV. Provider business mailing address

1768 ROUTE 9
HALFMOON NY
12065-2402
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2663
  • Fax:
Mailing address:
  • Phone: 518-489-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: