Provider Demographics
NPI:1467006239
Name:FRONK, MICHAEL (NVSI)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FRONK
Suffix:
Gender:M
Credentials:NVSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 PEACEFUL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4306
Mailing Address - Country:US
Mailing Address - Phone:775-848-6327
Mailing Address - Fax:
Practice Address - Street 1:9110 DOUBLE DIAMOND PKWY STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5039
Practice Address - Country:US
Practice Address - Phone:775-848-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVSI.0012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist