MEDICARE: THERAPEUTIC DYNAMICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251H1200X	Hand Physical Therapist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist	PT006667	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52068657-004	OTHER	GA	BCBSGA PPO PIN
2	7480721	OTHER	GA	AETNA PPO POS PIN

General Provider Information

NPI Number	:	1790832566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC DYNAMICS

Provider Business Mailing Address
First Line	:	1810 PEACHTREE INDUSTRIAL BLVD STE 130
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8175
Country	:	US
Telephone Number	:	770-232-7100
Fax Number	:	770-232-7198

Provider Business Practice Location Address
First Line	:	1810 PEACHTREE INDUSTRIAL BLVD
Second Line	:	SUITE 130
City	:	DULUTH
State	:	GA
Zip	:	30097-8180
Country	:	US
Telephone Number	:	770-232-7100
Fax Number	:	770-232-7198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JON MICHAEL PRESTON
Credential	:	M.S.P.T.
Telephone Number	:	770-232-7100

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	06/04/2026

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Directions to “THERAPEUTIC DYNAMICS ” Practice Location

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