Jonathan Rex Gustavson, MSPT

NPI #1003007808 in Portland, Oregon

Provider Information

NPI Number: 1003007808
Entity Type: Individual
Name: Jonathan Rex Gustavson, MSPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: MSPT
Enumeration Date: Aug 6, 2007
Last Updated: Dec 30, 2021

Practice Location

Address: 3426 NE 62ND AVE
City: Portland
State: Oregon
ZIP Code: 97213-3953
Phone: (503) 312-3443

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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