Healthcare Provider Details

I. General information

NPI: 1497674360
Provider Name (Legal Business Name): MARTHA STARTUP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S SIZER AVE STE B
JEFFERSON CITY TN
37760-2421
US

IV. Provider business mailing address

1603 CARDINAL DR
MORRISTOWN TN
37814-3308
US

V. Phone/Fax

Practice location:
  • Phone: 865-262-9044
  • Fax: 865-262-9045
Mailing address:
  • Phone: 865-262-9044
  • Fax: 865-262-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5935
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: