| Entity Name: | SPORT AND SPINE PHYSICAL THERAPY AND WELLNESS CENTER, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jun 2009 (16 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Jan 2011 (14 years ago) |
| Document Number: | L09000053648 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 17824 N. US 41 Hwy, Lutz, FL, 33549, US |
| Mail Address: | 17824 N. US 41 Hwy, Lutz, FL, 33549, US |
| ZIP code: | 33549 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629350137 | 2011-09-12 | 2018-07-12 | 17824 N US HIGHWAY 41, LUTZ, FL, 335494502, US | 17824 N US HIGHWAY 41, LUTZ, FL, 33549, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-948-1020 |
| Fax | 8139481022 |
Authorized person
| Name | RYAN P WHELTON |
| Role | OWNER |
| Phone | 8139481020 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | PT22249 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 169-9988006 |
| State | FL |
| Issuer | CAQH |
| Number | 12098575 |
| State | FL |
| Issuer | PTAN |
| Number | CZ108A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WHELTON RYAN P | Agent | 8220 Sequester Loop, LAND O LAKES, FL, 34637 |
| Name | Role | Address |
|---|---|---|
| WHELTON RYAN PDr. | Director | 8220 Sequester Loop, LAND O LAKES, FL, 34637 |
| Name | Role | Address |
|---|---|---|
| WHELTON RYAN PDr. | President | 8220 Sequester Loop, LAND O LAKES, FL, 34637 |
| Name | Role | Address |
|---|---|---|
| WHELTON RYAN PDr. | Treasurer | 8220 Sequester Loop, LAND O LAKES, FL, 34637 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-03 | WHELTON, RYAN P | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-09 | 17824 N. US 41 Hwy, Lutz, FL 33549 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-09 | 17824 N. US 41 Hwy, Lutz, FL 33549 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-09 | 8220 Sequester Loop, LAND O LAKES, FL 34637 | No data |
| REINSTATEMENT | 2011-01-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-03-09 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-02-12 |
| ANNUAL REPORT | 2016-04-06 |
| ANNUAL REPORT | 2015-06-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
