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General NPI Number Information
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NPI Number | 1891658605
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Entity Type | Organization
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Legal Business Name | RADIANT ROOTS PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 319 MAVERICK RD
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City | WOODSTOCK
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State | NY
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Zip | 12498-2501
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Country | US
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Telephone | 518-810-9397
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Fax | 844-929-1404
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Provider Business Mailing Address
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Address Line | PO BOX 4017
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City | HALFMOON
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State | NY
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Zip | 12065-0850
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Country | US
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Telephone | 518-810-9397
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Fax | 844-929-1404
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | ALICIA KOWSKY
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Credential | DPT, PT
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Telephone | 518-810-9397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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