Healthcare Provider Details

I. General information

NPI: 1801072574
Provider Name (Legal Business Name): CONVERGENT THERAPIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2008
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 50TH ST CT NW SUITE 205-C
GIG HARBOR WA
98335
US

IV. Provider business mailing address

3214 50TH ST CT NW SUITE 205-C
GIG HARBOR WA
98335
US

V. Phone/Fax

Practice location:
  • Phone: 253-254-5653
  • Fax: 253-235-3656
Mailing address:
  • Phone: 253-254-5653
  • Fax: 253-235-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60423749
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00019867
License Number StateWA

VIII. Authorized Official

Name: MR. LUTHER KHANH CHAU
Title or Position: CEO
Credential: DC, LMP
Phone: 253-254-5653