Provider Demographics
NPI:1508217548
Name:FAULKNER, LAINEY
Entity Type:Individual
Prefix:
First Name:LAINEY
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 SW BINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6003
Mailing Address - Country:US
Mailing Address - Phone:785-230-8577
Mailing Address - Fax:
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:785-232-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant