Individual provider · NPI-1

Jonathan Peter Berg, massage therapist Or

Mechanotherapist · Portland, OR

NPI number1679959936
StatusActive
Last updated in NPPESAug 9, 2015

Details

NPI
1679959936
Entity type
Individual (NPI-1)
Name
Mr. Jonathan Peter Berg
Credential
massage therapist Or
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 9, 2015
Last updated
Aug 9, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172M00000X Mechanotherapist1363ORYes

Practice location

5010 Ne 33rd Ave
Portland, OR 97211-6946

Phone 503-310-5426

Mailing address

3618 Ne Cesar E Chavez Blvd
Portland, OR 97212-1920

Phone 503-310-5426

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