Healthcare Provider Details

I. General information

NPI: 1790832566
Provider Name (Legal Business Name): THERAPEUTIC DYNAMICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 PEACHTREE INDUSTRIAL BLVD SUITE 130
DULUTH GA
30097-8180
US

IV. Provider business mailing address

1810 PEACHTREE INDUSTRIAL BLVD STE 130
DULUTH GA
30097-8175
US

V. Phone/Fax

Practice location:
  • Phone: 770-232-7100
  • Fax: 770-232-7198
Mailing address:
  • Phone: 770-232-7100
  • Fax: 770-232-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006667
License Number StateGA

VIII. Authorized Official

Name: JON MICHAEL PRESTON
Title or Position: PRESIDENT
Credential: M.S.P.T.
Phone: 770-232-7100