Provider Demographics
NPI:1154204071
Name:MARCELLINO, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MARCELLINO
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 1:706 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3419
Mailing Address - Country:US
Mailing Address - Phone:601-342-7774
Mailing Address - Fax:
Practice Address - Street 1:280 GA-74
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:678-528-1135
Practice Address - Fax:678-528-1268
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist