| Entity Name: | PEDIATRIC THERAPY OF ORMOND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Jul 2007 (18 years ago) |
| Document Number: | L07000070423 |
| FEI/EIN Number | 510641424 |
| Address: | 16 BLACK WATER WAY, ROOM 1, ORMOND BEACH, FL, 32174 |
| Mail Address: | 16 BLACK WATER WAY, ROOM 1, ORMOND BEACH, FL, 32174 |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679227508 | 2022-02-09 | 2022-02-09 | 16 BLACK WATER WAY, ORMOND BEACH, FL, 321745706, US | 16 BLACK WATER WAY, ORMOND BEACH, FL, 321745706, US | |||||||||||||||||||||
|
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| Phone | +1 386-871-0428 |
| Fax | 3864638565 |
Authorized person
| Name | TERI ESSIG |
| Role | OWNER |
| Phone | 3868710428 |
Taxonomy
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016451300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ESSIG TERI L | Agent | 16 BLACK WATER WAY, ROOM 1, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| ESSIG TERI L | Managing Member | 16 BLACK WATER WAY, ROOM 1, ORMOND BEACH, FL, 32174 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-05 |
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-01-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
