| Entity Name: | IMPACT THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Feb 2006 (19 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 01 Feb 2022 (3 years ago) |
| Document Number: | L06000019588 |
| FEI/EIN Number | 043845014 |
| Address: | 1725 Hermitage Boulevard, TALLAHASSEE, FL, 32308, US |
| Mail Address: | 1725 Hermitage Boulevard, TALLAHASSEE, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649840687 | 2021-07-01 | 2024-06-26 | 1717 HERMITAGE BLVD, TALLAHASSEE, FL, 323087709, US | 1717 HERMITAGE BLVD, TALLAHASSEE, FL, 323087709, US | |||||||||||||||||||||
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| Phone | +1 850-325-6301 |
| Fax | 8503256302 |
Authorized person
| Name | KELLY QUIN PREJEAN |
| Role | CLINIC DIRECTOR |
| Phone | 8503256301 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 891453200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KOLKA KEVIN | Agent | 1725 Hermitage Boulevard, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| KOLKA KEVIN | Managing Member | 1725 HERMITAGE BOULEVARD, TALLAHASSEE, FL, 32308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2022-02-01 | IMPACT THERAPY, LLC | No data |
| LC AMENDED/RESTATED ARTICLE/NAME CHANGE | 2020-09-21 | PROGRESSIVE PEDIATRIC THERAPY SERVICES, LLC. | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-10 | KOLKA, KEVIN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-08 | 1725 Hermitage Boulevard, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-12 | 1725 Hermitage Boulevard, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-12 | 1725 Hermitage Boulevard, TALLAHASSEE, FL 32308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-04-06 |
| LC Name Change | 2022-02-01 |
| ANNUAL REPORT | 2021-05-21 |
| LC Amended/Restated Article/NC | 2020-09-21 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
