MEDICARE: GRANT BELSOME PT, DPT

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	2251X0800X	Orthopedic Physical Therapist	11569	LA

General Provider Information

NPI Number	:	1861355778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT BELSOME PT, DPT

Provider Business Mailing Address
First Line	:	2 ORPHEUM AVE APT D
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-4553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 VETERANS MEMORIAL BLVD STE 160
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-5329
Country	:	US
Telephone Number	:	504-433-7250
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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