Provider Demographics
NPI:1992512610
Name:ECKER LEVY, MEL (LMT)
Entity type:Individual
Prefix:
First Name:MEL
Middle Name:
Last Name:ECKER LEVY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:MELAINA
Other - Middle Name:BRYNN
Other - Last Name:ECKER LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3057
Mailing Address - Country:US
Mailing Address - Phone:914-874-7206
Mailing Address - Fax:
Practice Address - Street 1:2205 N LOMBARD ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5770
Practice Address - Country:US
Practice Address - Phone:503-893-4407
Practice Address - Fax:503-908-6153
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist