Provider Demographics
NPI:1548298698
Name:MARINELLO, KRISTINE E (PT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:MARINELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5559 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-7203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 JOHNSON FERRY RD
Practice Address - Street 2:SUITE A-12
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4379
Practice Address - Country:US
Practice Address - Phone:770-321-4721
Practice Address - Fax:770-579-7060
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22712225100000X
GAPT008403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist