Provider Demographics
NPI:1063982908
Name:ROLLERSON, TEIKEITA MARIA
Entity type:Individual
Prefix:
First Name:TEIKEITA
Middle Name:MARIA
Last Name:ROLLERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33477
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-0477
Mailing Address - Country:US
Mailing Address - Phone:215-840-5353
Mailing Address - Fax:610-449-5272
Practice Address - Street 1:8711 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082
Practice Address - Country:US
Practice Address - Phone:215-840-5353
Practice Address - Fax:610-449-5272
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator