Healthcare Provider Details

I. General information

NPI: 1316868037
Provider Name (Legal Business Name): AVERY CORTEZ PETRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 CORNWALL AVE
BELLINGHAM WA
98225-3719
US

IV. Provider business mailing address

1655 MAIN ST
FERNDALE WA
98248-9029
US

V. Phone/Fax

Practice location:
  • Phone: 360-671-5706
  • Fax:
Mailing address:
  • Phone: 601-818-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70134088
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: