Healthcare Provider Details

I. General information

NPI: 1982514253
Provider Name (Legal Business Name): ERIC W. SMITH PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 CRAIN HWY STE C-170
UPPER MARLBORO MD
20772-4258
US

IV. Provider business mailing address

443 BIRCH DR
EDGEWATER MD
21037-3322
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3127
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: