| Entity Name: | INTRACOASTAL PHYSICAL THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Sep 2002 (22 years ago) |
| Date of dissolution: | 03 Apr 2024 (10 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 03 Apr 2024 (10 months ago) |
| Document Number: | L02000023677 |
| FEI/EIN Number | 522383277 |
| Address: | 4957 Rosewood Lane, Melbourne, FL, 32940, US |
| Mail Address: | 4957 ROSEWOOD LANE, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962483370 | 2005-11-11 | 2020-08-22 | 308 S HARBOR CITY BLVD, SUITE B, MELBOURNE, FL, 329011500, US | 308 S HARBOR CITY BLVD, SUITE B, MELBOURNE, FL, 329011500, US | |||||||||||||||||||||
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| Phone | +1 321-951-2416 |
| Fax | 3219512077 |
Authorized person
| Name | MR. MATTHEW KARL THOMPSON |
| Role | OWNER |
| Phone | 3219512416 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS/BLUE SHIELD GR |
| Number | Y902W |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMPSON MATTHEW | Agent | 4957 ROSEWOOD LANE, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| THOMPSON MATTHEW | President | 4957 ROSEWOOD LANE, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-04-03 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-11 | 4957 Rosewood Lane, Melbourne, FL 32940 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-04-03 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-02-12 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-03-13 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-04-07 |
| ANNUAL REPORT | 2016-04-11 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
