Healthcare Provider Details

I. General information

NPI: 1275457350
Provider Name (Legal Business Name): LAUREN BUSSELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 RANCHO CONEJO BLVD
NEWBURY PARK CA
91320-1718
US

IV. Provider business mailing address

6300 BERTRAND AVE
ENCINO CA
91316-7140
US

V. Phone/Fax

Practice location:
  • Phone: 844-472-1476
  • Fax:
Mailing address:
  • Phone: 818-515-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: