Provider Demographics
NPI:1679108088
Name:GEKELMAN, ANNA (LMT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GEKELMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BRAZIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1640 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1922
Mailing Address - Country:US
Mailing Address - Phone:503-339-7351
Mailing Address - Fax:503-584-1822
Practice Address - Street 1:1640 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1922
Practice Address - Country:US
Practice Address - Phone:503-339-7351
Practice Address - Fax:503-584-1822
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist