Provider Demographics
NPI:1093292039
Name:MARINOS, CORY CHRISTOS
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:CHRISTOS
Last Name:MARINOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRIGHTON TER
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1814
Mailing Address - Country:US
Mailing Address - Phone:301-335-1403
Mailing Address - Fax:
Practice Address - Street 1:121 CONGRESSIONAL LN STE 602
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1562
Practice Address - Country:US
Practice Address - Phone:301-770-1613
Practice Address - Fax:301-770-1615
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant