Individual provider Active NPI

Amanda Jayashki Nugaliyadda Hanson, PT

  • Physical Therapist
  • Southfield, MI
National Provider Identifier
1295231389
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501303372 Issued in MI
Practice address
22250 Providence Dr Ste 405
Southfield, MI 48075-6212
Phone
(866) 974-2673
Fax
(866) 939-2673
NPI assigned
Apr 5, 2018
Last updated
Aug 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501303372 MI Primary
Physical Therapy Assistant 225200000X 5502005497 MI

Addresses

Primary practice location

22250 Providence Dr Ste 405
Southfield, MI 48075-6212

Mailing address

33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258

Other practice location 1

19930 Poinciana
Redford, MI 48240-1654
Phone (734) 228-4101

Other practice location 2

26750 Providence Pkwy Ste 240
Novi, MI 48374-1211
Phone (248) 687-7440

Other practice location 3

14800 Farmington Rd
Livonia, MI 48154-5461
Phone (734) 743-8880

Other practice location 4

2700 E Grand River Ave
Howell, MI 48843-8550
Phone (517) 225-3040

Other names 1

  • Amanda Nugaliyadda Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240715000690 MI Practitioner - Physical Therapist in Private Practice 8426593484 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22250 Providence Dr
Suite 401
Southfield, MI 48075-6212
Phone (248) 563-0306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501303372MIMDPhysical Therapist
5502005497MIMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Porretta Center for Orthopaedic Surgery, PLLC Physical Therapist CurrentSince Jul 15, 2024 Accepting new patients
The Porretta Center for Orthopaedic Surgery, PLLC CurrentSince Jul 15, 2024 Accepting new patients
Team Rehabilitation Services, LLC Physical Therapist CurrentSince Dec 22, 2025 Accepting new patients
Team Rehabilitation Services, LLC Physical Therapist CurrentSince Dec 22, 2025 Accepting new patients
The Porretta Center for Orthopaedic Surgery, PLLC Past Accepting new patients
Medical X-Ray Consultants, LTD Past Accepting new patients
The Porretta Center for Orthopaedic Surgery, PLLC Past Accepting new patients
The Porretta Center for Orthopaedic Surgery, PLLC Past Accepting new patients

Locations

18444 N 25th Ave
Ste 310
Phoenix, AZ 85023
Phone (623) 241-8706

16000 Southfield Rd
Allen Park, MI 48101
Phone (313) 359-8867

485 Columbia Ave E
Ste 10
Battle Creek, MI 49014
Phone (269) 719-8110

33900 Harper Ave
Ste 104
Clinton Twp, MI 48035
Phone (586) 416-9100

26750 Providence Pkwy
#240
Novi, MI 48374
Phone (248) 349-7843

26750 Providence Pkwy
Ste 240
Novi, MI 48374
Phone (248) 687-7440

22250 Providence Dr
Ste 40
Southfield, MI 48075
Phone (248) 563-0306

22250 Providence Dr
Ste 401
Southfield, MI 48075
Phone (248) 349-7015

22250 Providence Dr
Ste 405
Southfield, MI 48075
Phone (248) 465-5140

27652 Franklin Rd
Southfield, MI 48034
Phone (248) 359-8700

Interoperability endpoints

  • Direct secure messaging: amanda.nugaliyadda.1@22724.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1295231389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR STE 405",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480756212",
            "telephone_number": "866-974-2673",
            "fax_number": "866-939-2673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19930 Poinciana",
            "address_purpose": "LOCATION",
            "city": "Redford",
            "state": "MI",
            "postal_code": "482401654",
            "country_code": "US",
            "telephone_number": "734-228-4101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26750 Providence Pkwy Ste 240",
            "address_purpose": "LOCATION",
            "city": "Novi",
            "state": "MI",
            "postal_code": "483741211",
            "country_code": "US",
            "telephone_number": "248-687-7440",
            "fax_number": "248-687-7441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14800 Farmington Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481545461",
            "country_code": "US",
            "telephone_number": "734-743-8880",
            "fax_number": "734-743-8889",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 E Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Howell",
            "state": "MI",
            "postal_code": "488438550",
            "country_code": "US",
            "telephone_number": "517-225-3040",
            "fax_number": "517-225-3045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSON",
        "first_name": "AMANDA",
        "middle_name": "JAYASHKI NUGALIYADDA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303372",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502005497",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "NUGALIYADDA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.