Provider Demographics
NPI:1326785023
Name:BUSSELL, TAYLOR VICTORIA (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:VICTORIA
Last Name:BUSSELL
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 1:120 TOPSPIN CIR
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-3179
Mailing Address - Country:US
Mailing Address - Phone:409-779-6158
Mailing Address - Fax:
Practice Address - Street 1:801 STEVE HAWKINS PKWY
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6303
Practice Address - Country:US
Practice Address - Phone:830-992-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist