Provider Demographics
NPI:1134998818
Name:DEFRANK, ROCKY
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:DEFRANK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 SIMON RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1734
Mailing Address - Country:US
Mailing Address - Phone:724-877-1807
Mailing Address - Fax:
Practice Address - Street 1:4774 SIMON RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-1734
Practice Address - Country:US
Practice Address - Phone:724-877-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker