Healthcare Provider Details

I. General information

NPI: 1578434221
Provider Name (Legal Business Name): JACOB RYCHCIK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 US-9 SUITE 1314-B
QUEENSBURY NY
12804
US

IV. Provider business mailing address

7 HEMPHILL PL STE 130
MALTA NY
12020-4482
US

V. Phone/Fax

Practice location:
  • Phone: 518-289-5242
  • Fax:
Mailing address:
  • Phone: 518-289-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: