Healthcare Provider Details

I. General information

NPI: 1235075573
Provider Name (Legal Business Name): CYPRESS PT MANDEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 HIGHWAY 22 STE 200
MANDEVILLE LA
70471-2518
US

IV. Provider business mailing address

5404 HIGHWAY 22 STE 200
MANDEVILLE LA
70471-2518
US

V. Phone/Fax

Practice location:
  • Phone: 985-317-0566
  • Fax: 985-317-0564
Mailing address:
  • Phone: 985-317-0566
  • Fax: 985-317-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA MCCLUNG SPECHT
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 985-466-1194