| Entity Name: | PHYSICAL MEDICINE AND REHABILITATION CONSULTANT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 17 Mar 2011 (14 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L11000032483 |
| Address: | 6175 SW 192 AVE, PEMBROKE PINES, FL, 33332 |
| Mail Address: | 6175 SW 192 AVE, PEMBROKE PINES, FL, 33332 |
| ZIP code: | 33332 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982984704 | 2011-08-24 | 2011-08-24 | 6175 SW 192ND AVE, PEMBROKE PINES, FL, 33332, US | 6175 SW 192ND AVE, PEMBROKE PINES, FL, 33332, US | |||||||||||||||||
|
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| Phone | +1 919-260-8760 |
Authorized person
| Name | DR. GREGORY SAMSON |
| Role | PHYSICIAN |
| Phone | 9192608760 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME 99900 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ALBERT CARLE N | Agent | 4105 NW 88 AVE, CORAL SPRINGS, FL, 33065 |
| Name | Role | Address |
|---|---|---|
| SAMSON GREGORY | Managing Member | 6175 SW 192 AVE, PEMBROKE PINES, FL, 33332 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2011-03-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
