Provider Demographics
NPI:1609008903
Name:LOWERY, BEAU BERNELL (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:BERNELL
Last Name:LOWERY
Suffix:
Gender:M
Credentials:PT, ATC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:SUIT #110
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-408-7990
Mailing Address - Fax:225-408-7989
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUIT #110
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-408-7990
Practice Address - Fax:225-408-7989
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05277R2251X0800X
LAATH.J003492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer