Provider Demographics
NPI:1326192683
Name:FAULK, LORNA LEWIS (COLON HYDROTHERAPIST)
Entity Type:Individual
Prefix:MS
First Name:LORNA
Middle Name:LEWIS
Last Name:FAULK
Suffix:
Gender:F
Credentials:COLON HYDROTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5039
Mailing Address - Country:US
Mailing Address - Phone:931-906-8083
Mailing Address - Fax:
Practice Address - Street 1:225 E MEADOW CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5039
Practice Address - Country:US
Practice Address - Phone:931-906-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0083573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist