MEDICARE: KHIN MAYTHU GARDNER

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	0019019772	VA

General Provider Information

NPI Number	:	1003649013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHIN MAYTHU GARDNER

Provider Business Mailing Address
First Line	:	1735 ALASKA CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3641
Country	:	US
Telephone Number	:	631-796-2630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 GALLOWS RD
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3913
Country	:	US
Telephone Number	:	703-323-5691
Fax Number	:	703-323-5692

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	01/11/2026

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Directions to “ KHIN MAYTHU GARDNER ” Practice Location

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