| Entity Name: | PROGRESSIVE REHABILITATION AGENCY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Jan 1984 (41 years ago) |
| Document Number: | G79919 |
| FEI/EIN Number | 592390574 |
| Address: | 2620 S. TAMIAMI TRAIL, Floor 3, SARASOTA, FL, 34239, US |
| Mail Address: | 2620 S. TAMIAMI TRAIL, Floor 3, SARASOTA, FL, 34239, US |
| ZIP code: | 34239 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124142799 | 2007-03-19 | 2015-04-10 | 2999 S TAMIAMI TRL, SARASOTA, FL, 342395141, US | 2999 S TAMIAMI TRL, SARASOTA, FL, 342395141, US | |||||||||||||||||||||||||
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| Phone | +1 941-955-1239 |
| Fax | 9419551089 |
Authorized person
| Name | MR. RICHARD HAUPT |
| Role | OWNER |
| Phone | 9419551239 |
Taxonomy
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| License Number | 106621 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | R08 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HAUPT RICK | Agent | 2620 s Tamiami trail, Sarasota, FL, 34239 |
| Name | Role | Address |
|---|---|---|
| HAUPT RICHARD | President | 2620 s Tamiami tr, Sarasota, FL, 34239 |
| Name | Role | Address |
|---|---|---|
| HAUPT CHASIE | Secretary | 2620 s Tamiami tr, Sarasota, FL, 34239 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000124556 | VENICE PHYSICAL THERAPY AND SPORTS MEDICINE, INC | ACTIVE | 2016-11-17 | 2026-12-31 | No data | 1776 S TAMIAMI TRAIL, VENICE, FL, 34293 |
| G14000065772 | RICK HAUPT PHYSICAL THERAPY | ACTIVE | 2014-06-25 | 2029-12-31 | No data | 2620 S TAMIAMI TRAIL, FLOOR 3, SARASOTA, FL, 34239 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2013-09-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| AMENDMENT | 2000-09-26 | No data | No data |
| REINSTATEMENT | 1998-11-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1998-10-16 | No data | No data |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
