Provider Demographics
NPI:1376099093
Name:LECLERC, ANNA CHRISTINE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:CHRISTINE
Last Name:LECLERC
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 1:3931 SE BROOKLYN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1626
Mailing Address - Country:US
Mailing Address - Phone:503-522-5323
Mailing Address - Fax:
Practice Address - Street 1:2024 SE CLINTON STREET
Practice Address - Street 2:ZENANA SPA AND WELLNESS CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-238-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10000171W00000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No171W00000XOther Service ProvidersContractor