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  5. COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A.

COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A.

Company Details

Entity Name: COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Jun 1973 (52 years ago)
Document Number: 604452
FEI/EIN Number 591466615
Address: 8000 SR64 E, BRADENTON, FL, 34212, US
Mail Address: 8000 SR64 E, BRADENTON, FL, 34212, US
ZIP code: 34212
County: Manatee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1942361522 2006-12-13 2022-02-11 6015 POINTE WEST BLVD, BRADENTON, FL, 342095532, US 6015 POINTE WEST BLVD, BRADENTON, FL, 342095532, US

Contacts
Phone +1 941-782-2000
Fax 9417941863

Authorized person
Name NANCY R BORGGREN
Role CREDENTIALING SURPERVISOR
Phone 9417820102

Taxonomy
Taxonomy Code 224Z00000X - Occupational Therapy Assistant
Is Primary No
Taxonomy Code 225000000X - Orthotic Fitter
Is Primary No
Taxonomy Code 225100000X - Physical Therapist
Is Primary Yes
Taxonomy Code 2251H1200X - Hand Physical Therapist
Is Primary No
Taxonomy Code 2251S0007X - Sports Physical Therapist
Is Primary No
Taxonomy Code 2251X0800X - Orthopedic Physical Therapist
Is Primary No
Taxonomy Code 225200000X - Physical Therapy Assistant
Is Primary No
Taxonomy Code 225700000X - Massage Therapist
Is Primary No
Taxonomy Code 225X00000X - Occupational Therapist
Is Primary No
Taxonomy Code 225XH1200X - Hand Occupational Therapist
Is Primary No

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
254900ITAUW8K868JB55 604452 US-FL GENERAL ACTIVE No data

Addresses
Legal c/o Cf Registered Agent, Inc., 100 S. Ashley Drive, Suite 400, Tampa, US-FL, US, 33602
Headquarters 6015 Pointe West Blvd., Bradenton, US-FL, US, 34209

Registration details
Registration Date 2021-05-07
Last Update 2022-05-08
Status LAPSED
Next Renewal 2022-05-07
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 604452

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA 401(K) PROFIT SHARING PLAN 2009 591466615 2010-09-28 COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A. 99
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1998-02-01
Business code 621111
Sponsor’s telephone number 9417921404
Plan sponsor’s address 6015 POINTE WEST BOULEVARD, BRADENTON, FL, 34209

Plan administrator’s name and address
Administrator’s EIN 591466615
Plan administrator’s name COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A.
Plan administrator’s address 6015 POINTE WEST BOULEVARD, BRADENTON, FL, 34209
Administrator’s telephone number 9417921404

Signature of
Role Plan administrator
Date 2010-09-28
Name of individual signing PAUL M. DUCK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CF REGISTERED AGENT, INC. Agent

Director

Name Role Address
VALADIE ARTHUR L Director 8000 SR 64 E., BRADENTON, FL, 34212
KUMAR AVINASH G Director 8000 SR 64 E., BRADENTON, FL, 34212
FRENCH JEFF Director 8000 SR 64 E., BRADENTON, FL, 34212
VALADIE ALAN Director 8000 SR 64 E., BRADENTON, FL, 34212
CASHEN DAVID L Director 8000 SR 64 E., BRADENTON, FL, 34212

President

Name Role Address
VALADIE ARTHUR L President 8000 SR 64 E., BRADENTON, FL, 34212

Secretary

Name Role Address
VALADIE ARTHUR L Secretary 8000 SR 64 E., BRADENTON, FL, 34212

Treasurer

Name Role Address
VALADIE ARTHUR L Treasurer 8000 SR 64 E., BRADENTON, FL, 34212

Chief Executive Officer

Name Role Address
LEMAY PAIGE Chief Executive Officer 8000 SR 64 E., BRADENTON, FL, 34212

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000113075 COASTAL ANESTHESIA SERVICES EXPIRED 2011-11-21 2016-12-31 No data 6015 POINTE WEST BLVD., BRADENTON, FL, 34209
G09000108071 COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA EXPIRED 2009-05-18 2024-12-31 No data 6015 POINTE WEST BLVD., BRADENTON, FL, 34209
G09000106855 COASTAL ORTHOPEDICS & SPORTS MEDICINE EXPIRED 2009-05-13 2024-12-31 No data 6015 POINTE WEST BLVD., BRADENTON, FL, 34209
G09000106869 COASTAL ORTHOPEDICS & PAIN MANAGEMENT EXPIRED 2009-05-13 2014-12-31 No data 6015 POINTE WEST BLVD, BRADENTON, FL, 34209
G09000106878 COASTAL PAIN MANAGEMENT & REHABILITATION EXPIRED 2009-05-13 2024-12-31 No data 6015 POINTE WEST BLVD, BRADENTON, FL, 34209

Events

Event Type Filed Date Value Description
AMENDMENT 2011-10-13 No data No data
AMENDMENT 2005-03-21 No data No data
NAME CHANGE AMENDMENT 2004-10-04 COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FLORIDA, P.A. No data
NAME CHANGE AMENDMENT 1998-04-06 BRADENTON ORTHOPAEDIC ASSOCIATES, P.A. No data
NAME CHANGE AMENDMENT 1982-06-22 TOWNSEND, LASSEN, ROGERS AND DUNLAP, M.D.'S,P.A. No data
NAME CHANGE AMENDMENT 1977-09-01 TOWNSEND, LASSEN AND ROGERS, M.D.'S P.A. No data
NAME CHANGE AMENDMENT 1974-06-05 TOWNSEND AND LASSEN, M.D.'S P.A. No data

Related by officers

VALADIE ARTHUR L

CORE SELF STORAGE, LLC

KUMAR AVINASH G

ANESTHESIA PARTNERS OF MANATEE, LLC ANESTHESIOLOGY ASSOCIATES OF THE GULF COAST, LLC

FRENCH JEFF

COASTAL ORTHOPEDICS-SR 64 OWNERS ASSOCIATION, INC. BISLANE PROPERTY MANAGMENT CORP. JOHN WRIGHT CONSTRUCTION COMPANY, INC.

LEMAY PAIGE

PB ATHLETICS L.L.C. COASTAL ORTHOPEDICS-SR 64 OWNERS ASSOCIATION, INC. COASTAL SURGERY PARTNERS, L.L.C.

VALADIE ALAN

BUNGALOW PARK HOMEOWNERS' ASSOCIATION, INC. OUTPATIENT SURGICAL RECOVERY SUITES OF WESTERN FLORIDA LLC

Related by address

8000 SR64 E, BRADENTON, FL, 34212, US

COASTAL SURGERY PARTNERS, L.L.C.

8000 SR64 E, BRADENTON, FL, 34212, US

COASTAL SURGERY PARTNERS, L.L.C.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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