Healthcare Provider Details

I. General information

NPI: 1326785023
Provider Name (Legal Business Name): TAYLOR VICTORIA BUSSELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692B HOSPITAL DR STE 202
SANTA FE NM
87505-4825
US

IV. Provider business mailing address

120 TOPSPIN CIR
SPICEWOOD TX
78669-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-6399
  • Fax: 505-982-3219
Mailing address:
  • Phone: 409-779-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2023-2293
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: