Jonathan Rex Gustavson
Physical Therapist
3426 Ne 62nd Ave
Portland
, Oregon 97213-3953
Jonathan Rex Gustavson
Physical Therapist
3426 Ne 62nd Ave
Portland
, Oregon 97213-3953
(503) 312-3443
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About
Features
Specialties
- Physical Therapist
Languages spoken
- English
Location
First Address
- Jonathan Rex Gustavson
- 3426 Ne 62nd Ave
- Portland, OR
- Zip : 97213-3953
- Phone : (503) 312-3443
Second Address
- Jonathan Rex Gustavson
- 3426 Ne 62nd Ave
- Portland, OR
- Zip : 97213-3953
- Phone : (503) 312-3443
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 4932 | OR |
National Provider Identifier
| NPI | 1003007808 |
|---|---|
| Provider Name | Jonathan Rex Gustavson |
| First Address | Portland, OR 97213-3953 |
| Second Address | Portland, OR 97213-3953 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/08/2007 |
| Last Update Date | 30/12/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.