Provider Demographics
NPI:1295722759
Name:LOWERY, BUFORD CRAIG (PT)
Entity type:Individual
Prefix:MR
First Name:BUFORD
Middle Name:CRAIG
Last Name:LOWERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 WESTLAKE RD
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3226
Mailing Address - Country:US
Mailing Address - Phone:318-372-0463
Mailing Address - Fax:
Practice Address - Street 1:7410 WESTLAKE RD
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3226
Practice Address - Country:US
Practice Address - Phone:318-372-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139963Medicaid
LA1139963Medicaid
LA1139963Medicaid