Provider Demographics
NPI:1841032547
Name:ROCK, DEBORAH RICHARDSON (PROSTHETIC PROVIDER)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RICHARDSON
Last Name:ROCK
Suffix:
Gender:F
Credentials:PROSTHETIC PROVIDER
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:R
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPECIALIST
Mailing Address - Street 1:1702 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-3604
Mailing Address - Country:US
Mailing Address - Phone:318-461-6443
Mailing Address - Fax:
Practice Address - Street 1:531 LOUISE ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-3604
Practice Address - Country:US
Practice Address - Phone:318-461-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies