| Entity Name: | BACK IN ACTION, SAINT LUCIE PHYSICAL THERAPY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 27 Jun 2008 (17 years ago) |
| Date of dissolution: | 02 Dec 2009 (15 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Dec 2009 (15 years ago) |
| Document Number: | L08000063182 |
| FEI/EIN Number | 26-2893757 |
| Address: | 266 NW PEACOCK BOULEVARD, SUITE 2-204, PORT ST LUCIE, FL 34986 |
| Mail Address: | PO BOX 7666, PORT ST LUCIE, FL 34984 |
| ZIP code: | 34986 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407005812 | 2008-09-10 | 2009-04-24 | PO BOX 7666, PORT SAINT LUCIE, FL, 349857666, US | 266 NW PEACOCK BLVD, BUILDING 2 SUITE 2-204, PORT SAINT LUCIE, FL, 349862271, US | |||||||||||||||||||||||||
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| Phone | +1 772-408-6630 |
| Fax | 7724086750 |
Authorized person
| Name | MR. MARK SAPIO DOCUMENTO |
| Role | OWNER |
| Phone | 7724086630 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT20821 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER TRANSACTION ACCESS NUMBER |
| Number | BK845 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BEURY, KRISTEN | Agent | 624 SOUTH PALM AVENUE, SARASOTA, FL 34236 |
| Name | Role | Address |
|---|---|---|
| DOCUMENTO, MARK | Managing Member | 443 SE NOME DR., PORT ST LUCIE, FL 34984 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08217700162 | BACK IN ACTION | EXPIRED | 2008-08-04 | 2013-12-31 | No data | PO BOX 7666, PORT SAINT LUCIE, FL, 34985 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2009-12-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-30 | 266 NW PEACOCK BOULEVARD, SUITE 2-204, PORT ST LUCIE, FL 34986 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-04-30 | BEURY, KRISTEN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-30 | 624 SOUTH PALM AVENUE, SARASOTA, FL 34236 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2009-12-02 |
| ANNUAL REPORT | 2009-04-30 |
| Florida Limited Liability | 2008-06-27 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
