Individual
MR. JONATHAN PETER BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST OR
Contact information
Practice address
5010 NE 33RD AVE, PORTLAND, OR 97211-6946
(503) 310-5426
Mailing address
3618 NE CESAR E CHAVEZ BLVD, PORTLAND, OR 97212-1920
(503) 310-5426
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
1363
OR
Other
Enumeration date
08/09/2015
Last updated
08/09/2015
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