MEDICARE: CONVERGENT THERAPIES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00019867	WA
2	111N00000X	Chiropractor	60423749	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649324161	OTHER	WA	INDIVIDUAL NPI
2	1801072574	OTHER	WA	GROUP NPI

General Provider Information

NPI Number	:	1801072574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVERGENT THERAPIES, PLLC

Provider Business Mailing Address
First Line	:	3214 50TH ST CT NW
Second Line	:	SUITE 205-C
City	:	GIG HARBOR
State	:	WA
Zip	:	98335
Country	:	US
Telephone Number	:	253-254-5653
Fax Number	:	253-235-3656

Provider Business Practice Location Address
First Line	:	3214 50TH ST CT NW
Second Line	:	SUITE 205-C
City	:	GIG HARBOR
State	:	WA
Zip	:	98335
Country	:	US
Telephone Number	:	253-254-5653
Fax Number	:	253-235-3656

Authorized Official
Title or Position	:	CEO
Name	:	MR. LUTHER KHANH CHAU
Credential	:	DC, LMP
Telephone Number	:	253-254-5653

Provider Enumeration Date	:	01/12/2008
Last Update Date	:	08/27/2014

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