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Organization
CONVERGENCE PHYSICAL THERAPY AND PERFORMANCE
Active
Organization
CONVERGENCE PHYSICAL THERAPY AND PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER TANAKA PT, DPT (OWNER, PHYSICAL THERAPIST)
(808) 392-0058
Entity
Organization
Contact information
Practice address
303 S 5TH ST STE 140, SPRINGFIELD, OR 97477-5480
(541) 625-0191
Mailing address
224 W 37TH AVE, EUGENE, OR 97405-3312
(808) 392-0058
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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