| Entity Name: | KICK SOME MASS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Oct 2010 (14 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Jan 2018 (7 years ago) |
| Document Number: | L10000109243 |
| FEI/EIN Number | 274213615 |
| Address: | 316 Parkridge Avenue, Orange Park, FL, 32065, US |
| Mail Address: | 316 Parkridge Avenue, Orange Park, FL, 32065, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790149516 | 2016-04-07 | 2016-10-10 | 316 PARKRIDGE AVE, ORANGE PARK, FL, 320657507, US | 316 PARKRIDGE AVE, ORANGE PARK, FL, 320657507, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-589-0750 |
| Fax | 9043758821 |
Authorized person
| Name | DR. JEFFREY ALLYN RUTERBUSCH |
| Role | PHYSICIAN |
| Phone | 9045890750 |
Taxonomy
| Taxonomy Code | 133N00000X - Nutritionist |
| Is Primary | No |
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | OS6403 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2083P0901X - Public Health & General Preventive Medicine Physician |
| License Number | OS6403 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | OS6403 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PTAN |
| Number | IP327A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ruterbusch Ruth A | Agent | 316 PARKRIDGE AVENUE, ORANGE PARK, FL, 32065 |
| Name | Role | Address |
|---|---|---|
| Ruterbusch Jeffrey A | Managing Member | 1839 Moorings Circle, Middleburg, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| Ruterbusch Ruth A | Manager | 1839 Moorings Cir, Middleburg, FL, 32068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-01-28 | Ruterbusch, Ruth Arlene | No data |
| LC AMENDMENT | 2018-01-18 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-10 | 316 PARKRIDGE AVENUE, ORANGE PARK, FL 32065 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-08-01 | 316 Parkridge Avenue, Orange Park, FL 32065 | No data |
| CHANGE OF MAILING ADDRESS | 2016-08-01 | 316 Parkridge Avenue, Orange Park, FL 32065 | No data |
| LC AMENDMENT | 2010-12-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-08 |
| LC Amendment | 2018-01-18 |
| AMENDED ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
