Angelika M Petrova

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00017403 Issued in WA

Practice address

5514 NE 107TH Ave
Suite 101
Vancouver, WA 98662-6346

Phone

(360) 254-0400

Fax

(360) 254-9022

NPI assigned

May 3, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A Family & Sports Chiropractic Clinic

  • Chiropractor
  • Vancouver, WA
  • NPI 1952779498
  NPD (past)
• Brie Chani Henderson

  • Chiropractor
  • Vancouver, WA
  • NPI 1730676545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093937757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 821477",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986820033",
            "telephone_number": "360-910-0040",
            "fax_number": "360-254-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5514 NE 107TH AVE",
            "address_2": "SUITE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626346",
            "telephone_number": "360-254-0400",
            "fax_number": "360-254-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVA",
        "first_name": "ANGELIKA",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00017403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0169505",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina Lynn Louie Peterson, CRNA
• Tod C Peterson
• Anna Michelle Petrey
• Heather Ann Petrik, RN
• Lyndsey Tyler Petrino
• Anna M Petruolo, LMP
• Danielle Mariah Pettet, DC
• Michael Pettet, DC
• Tyler Jonathon Pettett, LMHCA
• Theron M Pettit, MD

• Massage Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.