MEDICARE: MS. ANDREA M GORDON LMT, TTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	004010	NY

General Provider Information

NPI Number	:	1922762772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA M GORDON LMT, TTT

Provider Business Mailing Address
First Line	:	46 WOODBINE AVE STE 1
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2884
Country	:	US
Telephone Number	:	631-754-7505
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 WOODBINE AVE STE 1
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2884
Country	:	US
Telephone Number	:	631-754-7505
Fax Number	:	631-754-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	02/12/2026

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