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General NPI Number Information
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NPI Number | 1801072574
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Entity Type | Organization
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Legal Business Name | CONVERGENT THERAPIES, PLLC
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Dates
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Enumeration Date | 01/12/2008
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 3214 50TH ST CT NW SUITE 205-C
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-254-5653
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Fax | 253-235-3656
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Provider Business Mailing Address
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Address Line | 3214 50TH ST CT NW SUITE 205-C
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-254-5653
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Fax | 253-235-3656
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Authorized Official
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Title or Position | CEO
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Name | MR. LUTHER KHANH CHAU
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Credential | DC, LMP
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Telephone | 253-254-5653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00019867
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 60423749
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License Number State | WA
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