Individual provider
JONATHAN REX GUSTAVSON, MSPT
CMS NPPES lists JONATHAN REX GUSTAVSON as an individual provider record with NPI 1003007808. The current record reports a primary practice location in PORTLAND, OR and primary taxonomy code 225100000X.
Type 1 NPIs identify individual healthcare providers. How to read this profile
01
Practice locations
- Primary practice location3426 NE 62ND AVEPORTLAND, OR 972133953
Only source-designated practice locations are shown here. Mailing addresses are not presented as practice locations.
02
Taxonomy information
225100000XPrimary reported taxonomy
Taxonomy codes describe provider classifications reported to NPPES. Repeated identical codes are shown once, with primary-reported status preserved. They are not licenses, certifications, quality measures, or NPIFolio specialty labels. Read the taxonomy methodology.
03
NPI record information
- NPI status
- Enumerated in NPPES
- Enumeration date
- August 6, 2007
An NPI is a federal identifier. Enumeration and lifecycle information does not establish medical-license status, current practice, disciplinary history, provider quality, or whether a provider is accepting patients.