MEDICARE: JENNIFER MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61243	FL
2	225700000X	Massage Therapist	12637	TN

General Provider Information

NPI Number	:	1699550335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARTINEZ

Provider Business Mailing Address
First Line	:	219 DUNBAR CAVE RD STE A
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8844
Country	:	US
Telephone Number	:	931-434-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 DUNBAR CAVE RD STE A
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8844
Country	:	US
Telephone Number	:	931-434-6225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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Directions to “ JENNIFER MARTINEZ ” Practice Location

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