Healthcare Provider Details

I. General information

NPI: 1891658605
Provider Name (Legal Business Name): RADIANT ROOTS PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MAVERICK RD
WOODSTOCK NY
12498-2501
US

IV. Provider business mailing address

PO BOX 4017
HALFMOON NY
12065-0850
US

V. Phone/Fax

Practice location:
  • Phone: 518-810-9397
  • Fax: 844-929-1404
Mailing address:
  • Phone: 518-810-9397
  • Fax: 844-929-1404

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: ALICIA KOWSKY
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: DPT, PT
Phone: 518-810-9397