Healthcare Provider Details

I. General information

NPI: 1861355778
Provider Name (Legal Business Name): GRANT BELSOME PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 VETERANS MEMORIAL BLVD STE 160
METAIRIE LA
70006-5329
US

IV. Provider business mailing address

2 ORPHEUM AVE APT D
METAIRIE LA
70005-4553
US

V. Phone/Fax

Practice location:
  • Phone: 504-433-7250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11569
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: