Healthcare Provider Details

I. General information

NPI: 1245189281
Provider Name (Legal Business Name): ERIK CALVIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 W MARKET PL
FULTON MD
20759-2703
US

IV. Provider business mailing address

802 CORNWALL CT
SYKESVILLE MD
21784-6183
US

V. Phone/Fax

Practice location:
  • Phone: 410-826-0178
  • Fax:
Mailing address:
  • Phone: 443-909-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: