Provider Demographics
NPI:1376717280
Name:GAY, ANDREA BOOKER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:BOOKER
Last Name:GAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 BACK BAY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1697
Mailing Address - Country:US
Mailing Address - Phone:512-899-2437
Mailing Address - Fax:
Practice Address - Street 1:12912 HILL COUNTRY BLVD
Practice Address - Street 2:SUITE F-220
Practice Address - City:BEE CAVES
Practice Address - State:TX
Practice Address - Zip Code:78738-6328
Practice Address - Country:US
Practice Address - Phone:512-944-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53052225700000X
TXMT106745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist