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General NPI Number Information
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NPI Number | 1740168897
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Entity Type | Individual
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Provider Name | ANDREA MARJEAN GORDON LMT
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Gender | Female
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1820 GLYNWOOD DR STE D
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City | PRATTVILLE
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State | AL
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Zip | 36066-5533
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Country | US
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Telephone | 334-235-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 MINNEAPOLIS ST
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-3136
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Country | US
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Telephone | 334-235-1134
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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 | 7501001907
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6725
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License Number State | AL
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