| Entity Name: | PIVOTAL HEALTH PHYSICAL MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Jun 2010 (15 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 14 Nov 2022 (2 years ago) |
| Document Number: | L10000062824 |
| FEI/EIN Number | 27-2859387 |
| Address: | 12479 S ACCESS RD, SUITE 1, PORT CHARLOTTE, FL 33981 |
| Mail Address: | 1435 E Venice Ave, Suite 104, #279, Venice, FL 34292 |
| ZIP code: | 33981 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801169172 | 2012-02-17 | 2014-07-09 | 12479 S ACCESS RD, SUITE 1, PORT CHARLOTTE, FL, 339816206, US | 12479 S ACCESS RD, SUITE 1, PORT CHARLOTTE, FL, 339816206, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 941-697-3001 |
| Fax | 9416976010 |
Authorized person
| Name | DR. JEREMIAH B JOSEPH |
| Role | PRESIDENT |
| Phone | 9414737900 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8839 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Joseph, Kristin | Agent | 1425 E Venice Ave, Suite 104, #279, Venice, FL 34292 |
| Name | Role | Address |
|---|---|---|
| REJUVENX HOLDINGS | Manager | 1425 E Venice Ave, Suite 104, #279 Venice, FL 34292 |
| Name | Role | Address |
|---|---|---|
| JOSEPH, JEREMIAH | Authorized Representative | 8350 BEE RIDGE ROAD #198, SARASOTA, FL 34241 |
| DECANIO, TIM | Authorized Representative | 1425 E Venice Ave, Suite 104, #279 Venice, FL 34292 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000004674 | REJUVENX OF PORT CHARLOTTE, LLC | ACTIVE | 2018-01-09 | 2028-12-31 | No data | 1470 A ROYAL PALM BEACH BLVD, SUITE 1, ROYAL PALM BEACH, FL, 33411 |
| G17000141622 | REJUVENX OF PORT CHARLOTTE, LLC | ACTIVE | 2017-12-27 | 2027-12-31 | No data | 1470-A ROYAL PALM BEACH BLVD, SUITE 1, ROYAL PALM BEACH, FL, 33411 |
| G13000074468 | JOSEPH FAMILY HEALTH AND WELLNESS | EXPIRED | 2013-07-25 | 2018-12-31 | No data | 12479 S ACCESS RD SUITE 1, PORT CHARLOTTE, FL, 33981 |
| G10000118490 | PIVOTAL HEALTH FUNCTIONAL MEDICINE CENTERS OF SOUTH FLORIDA | EXPIRED | 2010-12-27 | 2015-12-31 | No data | 1811 ENGLEWOOD ROAD, #277, ENGLEWOOD, FL, 34223 |
| G10000103755 | PIVOTAL HEALTH FNCTIONAL MEDICINE CENTERS OF SOUTH FLORIDA | EXPIRED | 2010-11-12 | 2015-12-31 | No data | 1811 ENGLEWOOD ROAD, #277, ENGLEWOOD, FL, 34223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-10-15 | 12479 S ACCESS RD, SUITE 1, PORT CHARLOTTE, FL 33981 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 1425 E Venice Ave, Suite 104, #279, Venice, FL 34292 | No data |
| LC AMENDMENT | 2022-11-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-06 | Joseph, Kristin | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-05-01 | 12479 S ACCESS RD, SUITE 1, PORT CHARLOTTE, FL 33981 | No data |
| LC AMENDMENT AND NAME CHANGE | 2012-01-05 | PIVOTAL HEALTH PHYSICAL MEDICINE LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-12 |
| LC Amendment | 2022-11-14 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-02-16 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
