| Entity Name: | SOUTH FLORIDA PHYSICAL MEDICINE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Nov 2011 (13 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 14 Nov 2022 (2 years ago) |
| Document Number: | L11000129840 |
| FEI/EIN Number | 45-3810649 |
| Address: | 1470 Royal Palm Beach Blvd, Suite A, Royal Palm Beach, FL 33411 |
| Mail Address: | 1435 E Venice Avenue, Suite 104, #279, Venice, FL 34292 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417227455 | 2012-01-09 | 2012-03-29 | 1470 ROYAL PALM BEACH BLVD STE A, ROYAL PALM BEACH, FL, 334111608, US | 1470 ROYAL PALM BEACH BLVD STE A, ROYAL PALM BEACH, FL, 334111608, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 561-422-1819 |
Authorized person
| Name | KRISTEN CHALKLEY |
| Role | OFFICE MANAGER |
| Phone | 5614221819 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DeCanio, Tim, Dr. | Agent | 1435 E Venice Avenue, 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 | 1435 E Venice Avenue, Suite 104, #279 Venice, FL 34292 |
| Name | Role | Address |
|---|---|---|
| REJUVENX HOLDINGS | Manager | 1435 E Venice Avenue, Suite 104, #279 Venice, FL 34292 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000009910 | REJUVENX OF ROYAL PALM BEACH, LLC | ACTIVE | 2018-01-18 | 2028-12-31 | No data | 1470 A ROYAL PALM BEACH BLVD, SUITE A, ROYAL PALM BEACH, FL, 33411 |
| G17000138568 | REJUVENX OF ROYAL PALM BEACH, LLC | ACTIVE | 2017-12-19 | 2027-12-31 | No data | 1470 ROYAL PALM BEACH BLVD., STE. A, ROYAL PALM BEACH, FL, 33411 |
| G12000080870 | INTEGRATIVE HEALTH OF WEST PALM LLC | EXPIRED | 2012-08-15 | 2017-12-31 | No data | 1470 ROYAL PALM BEACH BLVD, STE A, ROYAL PALM BEACH, FL, 33411 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-29 | 1470 Royal Palm Beach Blvd, Suite A, Royal Palm Beach, FL 33411 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 1435 E Venice Avenue, Suite 104, #279, Venice, FL 34292 | No data |
| LC AMENDMENT | 2022-11-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-22 | DeCanio, Tim, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-17 | 1470 Royal Palm Beach Blvd, Suite A, Royal Palm Beach, FL 33411 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-11 |
| 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 | 2018-04-27 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-04-22 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
