Provider Demographics
NPI:1801072574
Name:CONVERGENT THERAPIES, PLLC
Entity type:Organization
Organization Name:CONVERGENT THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:KHANH
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LMP
Authorized Official - Phone:253-254-5653
Mailing Address - Street 1:3214 50TH ST CT NW
Mailing Address - Street 2:SUITE 205-C
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-254-5653
Mailing Address - Fax:253-235-3656
Practice Address - Street 1:3214 50TH ST CT NW
Practice Address - Street 2:SUITE 205-C
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-254-5653
Practice Address - Fax:253-235-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-12
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019867225700000X
WA60423749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649324161OtherINDIVIDUAL NPI
WA1801072574OtherGROUP NPI
WA0007530738Medicare UPIN
WA1649324161OtherINDIVIDUAL NPI
WA0193239Medicare UPIN