Healthcare Provider Details

I. General information

NPI: 1053819730
Provider Name (Legal Business Name): BRANDON BELLMAN PT, DPT, MS, AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 W 1ST AVE
GRANDVIEW HEIGHTS OH
43212-3302
US

IV. Provider business mailing address

4261 VALLEY QUAIL BLVD N
WESTERVILLE OH
43081-3734
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-3555
  • Fax:
Mailing address:
  • Phone: 440-522-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019743
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005741
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: