Provider Demographics
NPI:1912523630
Name:FRONCK, RACHEL (MT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FRONCK
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3274
Mailing Address - Country:US
Mailing Address - Phone:304-671-0562
Mailing Address - Fax:
Practice Address - Street 1:1636 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3274
Practice Address - Country:US
Practice Address - Phone:304-737-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2012-2968225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty