Provider Demographics
NPI:1831366988
Name:GORTON, ANDREA JOYCE (MPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOYCE
Last Name:GORTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33908 REDHAWK PL
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6971
Mailing Address - Country:US
Mailing Address - Phone:909-570-9429
Mailing Address - Fax:
Practice Address - Street 1:27620 LANDAU BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5540
Practice Address - Country:US
Practice Address - Phone:760-322-5090
Practice Address - Fax:760-322-9175
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT236192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT236190Medicare PIN
CAAW335ZMedicare UPIN