Amanda Illa Pickworth-Chrusciel, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501303770 Issued in MI

Practice address

17783 Haggerty Rd Ste B
Northville Charter Township, MI 48168-9802

Phone

(734) 895-1901

Fax

(855) 794-1008

NPI assigned

Jun 4, 2019

Last updated

Feb 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Amanda Illa Pickworth Former name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pryde Physical Therapy PLLCGroup PAC ID 2860801008, 5 clinicians

Back to You Rehab PLLCGroup PAC ID 2365789203, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Back to You Rehab PLLC

  dba Back to You Osteopractic Physical Therapy

  • Physical Therapist
  • Royal Oak, MI
  • NPI 1386124378
  Medicare reassignment Care Compare group NPD
• Pryde Physical Therapy PLLC

  dba Pryde Physical therapy

  • Physical Therapist
  • Canton, MI
  • NPI 1912503830
  Medicare reassignment Care Compare group NPD
• Stay in Motion PT PLLC

  • Physical Therapy Clinic/Center
  • Wixom, MI
  • NPI 1629948872
  Medicare reassignment NPD Authorized official
• Michigan Luna Care Physical Therapy, LLC

  • Physical Therapist
  • Ann Arbor, MI
  • NPI 1003448994
  NPD

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1821656950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5536 RESEARCH DR STE A",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481882261",
            "telephone_number": "734-895-1901",
            "fax_number": "855-794-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17783 HAGGERTY RD STE B",
            "city": "NORTHVILLE CHARTER TOWNSHIP",
            "state": "MI",
            "postal_code": "481689802",
            "telephone_number": "734-895-1901",
            "fax_number": "855-794-1008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5536 Research Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481882261",
            "country_code": "US",
            "telephone_number": "734-895-1901",
            "fax_number": "855-794-1008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PICKWORTH-CHRUSCIEL",
        "first_name": "AMANDA",
        "middle_name": "ILLA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-04",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003904",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "PICKWORTH",
            "middle_name": "ILLA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.