Provider Demographics
NPI:1558977744
Name:POWELL-GERTZ, ANNE-MARIA (CMT)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIA
Middle Name:
Last Name:POWELL-GERTZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7312
Mailing Address - Country:US
Mailing Address - Phone:323-651-4876
Mailing Address - Fax:
Practice Address - Street 1:925 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-2321
Practice Address - Country:US
Practice Address - Phone:323-337-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist