| Entity Name: | COASTAL PHYSICAL THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Dec 2008 (16 years ago) |
| Date of dissolution: | 14 Jan 2014 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 14 Jan 2014 (11 years ago) |
| Document Number: | L08000111850 |
| FEI/EIN Number | 800313724 |
| Address: | 15101 SHELL POINT BOULEVARD, FORT MYERS, FL, 33908 |
| Mail Address: | PO BOX 62095, FORT MYERS, FL, 33906 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275768194 | 2009-05-20 | 2010-09-16 | PO BOX 62095, FORT MYERS, FL, 339062095, US | 18990 PERSIMMON RIDGE RD, ALVA, FL, 339203367, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-681-0278 |
| Fax | 2392360217 |
Authorized person
| Name | VANESSA RACHEL MARTIN |
| Role | PRESIDENT |
| Phone | 19416810278 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | PT23483 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PTAN |
| Number | CM700A |
| State | FL |
| Issuer | CCN |
| Number | 920922584420-002 |
| State | FL |
| Issuer | MEDICARE NUMBER |
| Number | AN9692Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTIN JONATHAN | Agent | 2000 Main Street, Fort Myers, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| MARTIN VANESSA R | Managing Member | PO BOX 62095, FORT MYERS, FL, 33906 |
| MARTIN JONATHAN | Managing Member | PO BOX 62095, FORT MYERS, FL, 33906 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08344900104 | COASTAL PHYSICAL THERAPY, LLC | EXPIRED | 2008-12-08 | 2013-12-31 | No data | 17161 PALM BEACH BLVD., ALVA, FL, 33920 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-01-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-05-01 | MARTIN, JONATHAN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-05-01 | 2000 Main Street, Fort Myers, FL 33901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-10 | 15101 SHELL POINT BOULEVARD, FORT MYERS, FL 33908 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-19 | 15101 SHELL POINT BOULEVARD, FORT MYERS, FL 33908 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-01-14 |
| ANNUAL REPORT | 2013-05-01 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-04-19 |
| ANNUAL REPORT | 2010-02-26 |
| ANNUAL REPORT | 2009-04-12 |
| Florida Limited Liability | 2008-12-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
