MEDICARE: MR. RAYMOND A BELISLE MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	06525R	LA
2	225100000X	Physical Therapist	PT4978	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1033218524	OTHER	MS	GROUP NPI

General Provider Information

NPI Number	:	1326098252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND A BELISLE MSPT

Provider Business Mailing Address
First Line	:	PO BOX 8419
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39535-8087
Country	:	US
Telephone Number	:	228-388-5714
Fax Number	:	228-388-0017

Provider Business Practice Location Address
First Line	:	5132 BEATLINE RD
Second Line	:	SUITE D
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3869
Country	:	US
Telephone Number	:	228-575-8429
Fax Number	:	228-575-8891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/11/2012

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Directions to “ MR. RAYMOND A BELISLE MSPT” Practice Location

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