Provider Demographics
NPI:1578264552
Name:CYPRESS PT CHARLES LLC
Entity Type:Organization
Organization Name:CYPRESS PT CHARLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:985-308-0078
Mailing Address - Street 1:12807 HIGHWAY 90 STE 101
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-2214
Mailing Address - Country:US
Mailing Address - Phone:985-308-0078
Mailing Address - Fax:985-308-0248
Practice Address - Street 1:12807 HIGHWAY 90 STE 101
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-2214
Practice Address - Country:US
Practice Address - Phone:985-308-0078
Practice Address - Fax:985-308-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty