| Entity Name: | FLORIDA THERAPY CENTER OF MELBOURNE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 May 2002 (23 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Oct 2012 (12 years ago) |
| Document Number: | L02000012117 |
| FEI/EIN Number | 030453497 |
| Address: | 635 S Wickham Rd, Melbourne, FL, 32904, US |
| Mail Address: | 520 ANDROS LANE, Indian Harbour Beach, FL, 32937, US |
| ZIP code: | 32904 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144288986 | 2006-05-02 | 2023-08-10 | 635 S WICKHAM RD STE 103, MELBOURNE, FL, 329041436, US | 635 S WICKHAM RD STE 103, MELBOURNE, FL, 329041436, US | |||||||||||||||||||||
|
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| Phone | +1 321-890-7439 |
| Fax | 3217681710 |
Authorized person
| Name | MR. MATHEW SIMON KRONMAN |
| Role | ADMINISTRATOR |
| Phone | 3218907439 |
Taxonomy
| Taxonomy Code | 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | GF7 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KRONMAN MATHEW | Agent | 520 ANDROS LANE, INDIAN HARBOUR BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| KRONMAN MATHEW S | Manager | 520 Andros Lane, Indian Harbour Beach, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-09 | 635 S Wickham Rd, 103, Melbourne, FL 32904 | No data |
| CHANGE OF MAILING ADDRESS | 2015-05-04 | 635 S Wickham Rd, 103, Melbourne, FL 32904 | No data |
| REINSTATEMENT | 2012-10-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-06 | KRONMAN, MATHEW | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-05-04 | 520 ANDROS LANE, INDIAN HARBOUR BEACH, FL 32937 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J16000491856 | TERMINATED | 1000000719324 | BREVARD | 2016-08-12 | 2026-08-17 | $ 1,276.23 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MELBOURNE SERVICE CENTER, 6300 N WICKHAM RD STE 133A, MELBOURNE FL329402029 |
| J15001041348 | TERMINATED | 1000000690991 | BREVARD | 2015-08-12 | 2025-12-04 | $ 5,217.54 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MELBOURNE SERVICE CENTER, 6300 N WICKHAM RD STE 133A, MELBOURNE FL329402029 |
| J15000695417 | LAPSED | 14-680-D4 | LEON | 2015-04-06 | 2020-06-22 | $10,127.72 | DFS DIVISION OF WORKERS COMPENSATION, 200 EAST GAINES STREET, TALLAHASSEE, FL 32399-4228 |
| J14000661909 | LAPSED | 13-123-D4 | LEON | 2014-03-28 | 2019-05-29 | $1,000.00 | DFS, DIVISION OF WORKERS' COMPENSATION, 200 EAST GAINES STREET, TALLAHASSEE, FLORIDA 32399-4228 |
| J12000708431 | TERMINATED | 1000000391619 | BREVARD | 2012-10-11 | 2022-10-17 | $ 1,080.67 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, COCOA SERVICE CENTER, 2428 CLEARLAKE RD STE M, COCOA FL329225731 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-02-21 |
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-04-10 |
| ANNUAL REPORT | 2020-03-23 |
| ANNUAL REPORT | 2019-03-18 |
| ANNUAL REPORT | 2018-05-07 |
| ANNUAL REPORT | 2017-03-02 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-05-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
