MEDICARE: MISS LATEISHA ROLLERSON

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

General Provider Information

NPI Number	:	1154273837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LATEISHA ROLLERSON

Provider Business Mailing Address
First Line	:	12407 POPLAR VIEW DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3304
Country	:	US
Telephone Number	:	202-255-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	12407 POPLAR VIEW DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3304
Country	:	US
Telephone Number	:	202-255-9666
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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Directions to “ MISS LATEISHA ROLLERSON ” Practice Location

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