Amanda Gayle McCullough, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501011835 Issued in MI

Practice address

107 Schoolcrest Ave
Clare, MI 48617-1145

Phone

(989) 386-9170

Fax

(989) 386-9220

NPI assigned

Jun 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tmi East IncGroup PAC ID 3274864665, 62 clinicians

Fox Rehabilitation Services Mi LLCGroup PAC ID 2769819960, 84 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Fox Rehabilitation Services Mi LLC

  • Physical Therapist
  • Canton, MI
  • NPI 1790324648
  Medicare reassignment Care Compare group NPD
• Tmi East, Inc.

  • Rehabilitation Clinic/Center
  • Saginaw, MI
  • NPI 1336709252
  Medicare reassignment Care Compare group NPD
• Evergreen Physical Therapy Limited Partnership

  • Physical Therapist
  • Bay City, MI
  • NPI 1154647659
  NPD (past)

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1629013602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 SCHOOLCREST AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171145",
            "telephone_number": "989-386-9170",
            "fax_number": "989-386-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SCHOOLCREST AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171145",
            "telephone_number": "989-386-9170",
            "fax_number": "989-386-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "AMANDA",
        "middle_name": "GAYLE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501011835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehabilitation Services MI LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "5969 N Canton Center Rd",
            "city": "Canton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481872757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Clare, MI
• Providers in Clare, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.