Individual
JONATHAN REX GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
3426 NE 62ND AVE, PORTLAND, OR 97213-3953
(503) 312-3443
Mailing address
3426 NE 62ND AVE, PORTLAND, OR 97213-3953
(503) 312-3443
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4932
OR
Other
Enumeration date
08/06/2007
Last updated
12/30/2021
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