Provider Demographics
NPI:1699825422
Name:MARINO, PAUL A (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:MARINO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:736 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE A-12
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4379
Mailing Address - Country:US
Mailing Address - Phone:770-321-4720
Mailing Address - Fax:770-579-7060
Practice Address - Street 1:1809 CANTON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6343
Practice Address - Country:US
Practice Address - Phone:678-213-1560
Practice Address - Fax:678-213-1705
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT003365225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDDBMedicare ID - Type Unspecified