Provider Demographics
NPI:1184617821
Name:GORDON, ANDREA MARGARETA (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARGARETA
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5214
Mailing Address - Country:US
Mailing Address - Phone:912-356-1002
Mailing Address - Fax:912-356-1003
Practice Address - Street 1:5111 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5214
Practice Address - Country:US
Practice Address - Phone:912-356-1002
Practice Address - Fax:912-356-1003
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBZNMedicare ID - Type Unspecified