| Entity Name: | FLORIDA PHYSICAL THERAPY & REHABILITATIVE SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Oct 1978 (46 years ago) |
| Document Number: | 587336 |
| FEI/EIN Number | 59-1848963 |
| Address: | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 |
| Mail Address: | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417023730 | 2006-11-28 | 2020-04-22 | 600 W NORTH BLVD, SUITE D, LEESBURG, FL, 347485063, US | 600 W NORTH BLVD, SUITE D, LEESBURG, FL, 347485063, US | |||||||||||||||||||||||||
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| Phone | +1 352-728-6636 |
| Fax | 3527874522 |
Authorized person
| Name | MR. GERALD GOLDSTEIN |
| Role | VICE PRESIDENT |
| Phone | 3527286636 |
Taxonomy
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | R39 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Henderson, Kristi | PRESIDENT | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 |
| Name | Role | Address |
|---|---|---|
| Henderson, Kristi | DIRECTOR | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000050290 | LAKE CENTRE FOR REHABILITATION | ACTIVE | 2019-04-23 | 2029-12-31 | No data | 1650 LYNDON FARM CT STE 300, LOUISVILLE, KY, 40223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-20 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-20 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-27 | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-27 | 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY 40223 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| Reg. Agent Change | 2024-03-20 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-05-10 |
| ANNUAL REPORT | 2020-06-03 |
| Reg. Agent Change | 2019-10-14 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-03-16 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
