Provider Demographics
NPI:1568939585
Name:BROUSSARD, VICTORIA BURGER (DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BURGER
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 ERIC LN STE K
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5416
Mailing Address - Country:US
Mailing Address - Phone:336-270-5304
Mailing Address - Fax:
Practice Address - Street 1:2579 ERIC LN STE K
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5416
Practice Address - Country:US
Practice Address - Phone:336-270-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC183192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics