NPIMap

Organization Active NPI

Pryde Physical Therapy PLLC

Doing business as Pryde Physical therapy

  • Physical Therapist
  • Canton, MI
National Provider Identifier
1912503830
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRYDE PHYSICAL THERAPY PLLC
Doing business as
Pryde Physical therapy
Practice address
5536 Research Dr
Canton, MI 48188-2261
Phone
(734) 895-1901
NPI assigned
Dec 7, 2020
Last updated
Jul 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Ivan Ankwatsa
Title
Owner
Phone
(734) 895-1901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

5536 Research Dr
Canton, MI 48188-2261

Mailing address

5536 Research Dr Ste 186
Canton, MI 48188-2978
Phone (734) 895-1901

Other practice location 1

17783 Haggerty Rd Ste B
Northville, MI 48168-9802
Phone (734) 895-1901 ext. 2

Other names 1

  • Pryde Physical therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210429001730 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860801008 Receives reassigned benefits from 7 practitioners
Practice locations: Canton, MI; Northville, MI

National Provider Directory

National Provider Directory

Locations

5536 Research Dr
Canton, MI 48188
Phone (734) 895-1901

5536 Research Dr
Ste 186
Canton, MI 48188

17783 Haggerty Rd
Ste B
Northville, MI 48168
Phone (734) 895-1901

707 Parsons Rd
Ste C
Traverse City, MI 49686
Phone (734) 895-1901

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1912503830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5536 RESEARCH DR STE 186",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481882978",
            "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": "5536 RESEARCH DR",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481882261",
            "telephone_number": "734-895-1901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17783 Haggerty Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Northville",
            "state": "MI",
            "postal_code": "481689802",
            "country_code": "US",
            "telephone_number": "734-895-1901 x2",
            "fax_number": "855-794-1008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRYDE PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "ANKWATSA",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-895-1901"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pryde Physical therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.