Provider Demographics
NPI:1033145610
Name:CONVENTO, MACARIO AT
Entity type:Individual
Prefix:MR
First Name:MACARIO
Middle Name:AT
Last Name:CONVENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24007 84TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9392
Mailing Address - Country:US
Mailing Address - Phone:253-583-1810
Mailing Address - Fax:
Practice Address - Street 1:PUGET SOUND HEALTH CARE SYSTEM AMERICAN LAKE DIV.
Practice Address - Street 2:9600 VET. DR. SW
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1810
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant