Provider Demographics
NPI:1275505653
Name:HARMON, BUFORD K (PT)
Entity Type:Individual
Prefix:MR
First Name:BUFORD
Middle Name:K
Last Name:HARMON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:BICK
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1250 S SUNSET AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3961
Mailing Address - Country:US
Mailing Address - Phone:626-960-2853
Mailing Address - Fax:626-856-5512
Practice Address - Street 1:1250 S SUNSET AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-960-2853
Practice Address - Fax:626-856-5512
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0052990Medicaid
CAW14576Medicare PIN