MEDICARE: PURVIS CEDRIC ROLLINS

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	225700000X	Massage Therapist	MT1737	DC

General Provider Information

NPI Number	:	1316554819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PURVIS CEDRIC ROLLINS

Provider Business Mailing Address
First Line	:	3429 14TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3512
Country	:	US
Telephone Number	:	202-903-3757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 WASHINGTON PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-1070
Country	:	US
Telephone Number	:	202-618-2256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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Directions to “ PURVIS CEDRIC ROLLINS ” Practice Location

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