Individual
MAXINE ANDREA GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
738 SW MAIN BLVD, LAKE CITY, FL 32025-5768
(386) 400-3140
(386) 406-8013
Mailing address
738 SW MAIN BLVD, LAKE CITY, FL 32025-5768
(386) 400-3140
(386) 406-8013
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA106489
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558067579
GROUP NPI
FL
Enumeration date
12/19/2024
Last updated
03/08/2025
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