Healthcare Provider Details

I. General information

NPI: 1508077991
Provider Name (Legal Business Name): ESSENTIAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 MARTIN RD
CUMMING GA
30041-5533
US

IV. Provider business mailing address

4640 MARTIN RD
CUMMING GA
30041-5571
US

V. Phone/Fax

Practice location:
  • Phone: 678-679-1261
  • Fax: 678-250-9010
Mailing address:
  • Phone: 678-679-1261
  • Fax: 678-250-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TINA BLACK
Title or Position: OWNER
Credential: MS. OT/L
Phone: 770-378-5986