| Entity Name: | REHAB FRONTIER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Jul 2004 (21 years ago) |
| Document Number: | L04000050888 |
| FEI/EIN Number | 20-1197680 |
| Mail Address: | PO BOX 1168, LAKE WALES, FL 33859 |
| Address: | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 |
| ZIP code: | 33898 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285650648 | 2006-07-15 | 2008-04-17 | PO BOX 1168, LAKE WALES, FL, 338591168, US | 2027 STATE ROAD 60 E, LAKE WALES, FL, 338985113, US | |||||||||||||||||||||
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| Phone | +1 863-678-1557 |
| Fax | 8635829279 |
Authorized person
| Name | LOWELL S LIWANAG |
| Role | CHIEF MANAGER |
| Phone | 8636053681 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBSFL PROVIDER NUMBER |
| Number | Y922K |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LIWANAG, ROELA M | Agent | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 |
| Name | Role | Address |
|---|---|---|
| LIWANAG, LOWELL S | Managing Member | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 |
| PENNINGTON, KEVIN | Managing Member | 6007 PEBBLEBROOK LANE, MCDONALD, TN 37353 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-21 | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-21 | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-09 | LIWANAG, ROELA M | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-19 | 1007 OLD CUTLER ROAD, LAKE WALES, FL 33898 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-02-20 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-05-21 |
| ANNUAL REPORT | 2019-02-04 |
| ANNUAL REPORT | 2018-02-13 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-21 |
| ANNUAL REPORT | 2015-03-12 |
Date of last update: 29 Jan 2025
Sources: Florida Department of State
