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General NPI Number Information
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NPI Number | 1407485659
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Entity Type | Individual
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Provider Name | ANDREA MARIE GANCE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 3102 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4525
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Country | US
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Telephone | 253-565-0476
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Fax |
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Provider Business Mailing Address
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Address Line | 21803 42ND AVE E
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City | SPANAWAY
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State | WA
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Zip | 98387-6870
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Country | US
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Telephone | 253-476-0377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA.61007023
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License Number State | WA
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