Provider Demographics
NPI:1801081054
Name:MYBURGH, VICTOR PAURE (BS, PT)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:PAURE
Last Name:MYBURGH
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Gender:M
Credentials:BS, PT
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Mailing Address - Street 1:3603 BRAMBLETON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3611
Mailing Address - Country:US
Mailing Address - Phone:540-774-9000
Mailing Address - Fax:540-774-6666
Practice Address - Street 1:3603 BRAMBLETON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3611
Practice Address - Country:US
Practice Address - Phone:540-774-9000
Practice Address - Fax:540-774-6666
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305005863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist