Healthcare Provider Details

I. General information

NPI: 1699825422
Provider Name (Legal Business Name): PAUL A. MARINO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 CANTON RD SUITE 600
MARIETTA GA
30066-6343
US

IV. Provider business mailing address

736 JOHNSON FERRY RD SUITE A-12
MARIETTA GA
30068-4379
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-1560
  • Fax: 678-213-1705
Mailing address:
  • Phone: 770-321-4720
  • Fax: 770-579-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003365
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT003365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: