Most Relevant Information
Provider Data
| NPI Number: | 1003007808 |
| Provider Name: | JONATHAN REX GUSTAVSON MSPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 4932 |
Most Important Dates
| Enumeration Date: | 08/06/2007 |
| Last Updated: | 12/30/2021 |
Provider Practice Location
3426 NE 62ND AVE
PORTLAND
OR
972133953
Practice Location Phone/Fax
| Phone: | 5033123443 |
| Fax: |
Provider Mailing Location
3426 NE 62ND AVE
PORTLAND
OR
972133953
Provider Mailing Phone/Fax
| Phone: | 5033123443 |
| Fax: |