| Entity Name: | PARK LAKE PHYSICAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Nov 2011 (13 years ago) |
| Date of dissolution: | 13 Dec 2019 (5 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 13 Dec 2019 (5 years ago) |
| Document Number: | L11000132976 |
| FEI/EIN Number | 453861970 |
| Address: | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803, US |
| Mail Address: | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803, US |
| ZIP code: | 32803 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669749396 | 2011-11-23 | 2014-03-19 | 2206 E COLONIAL DR, ORLANDO, FL, 328034912, US | 2206 E COLONIAL DR, ORLANDO, FL, 328034912, US | |||||||||||||||||||||
|
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| Phone | +1 407-839-1045 |
| Fax | 4078391044 |
Authorized person
| Name | MRS. SHELBY ANNE REID |
| Role | MANAGER |
| Phone | 4078391045 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DMERC |
| Number | 6694190001 |
| State | FL |
| Name | Role |
|---|---|
| KABA CONSULTING INC. | Agent |
| Name | Role | Address |
|---|---|---|
| INTEGRATIVE PHYSICAL MEDICINE HOLDING, LLC | Manager | 425 ALEXANDRIA BLVD, OVIEDO, FL, 32765 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000076435 | COMPLETE CARE | EXPIRED | 2019-07-15 | 2024-12-31 | No data | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803 |
| G18000083169 | INTEGRATIVE PHYSICAL MEDICINE | EXPIRED | 2018-08-01 | 2023-12-31 | No data | 2206 E COLONIAL DR, ORLANDO, FL, 32806 |
| G14000052446 | COLTEN HEALTHCARE MANAGEMENT | EXPIRED | 2014-05-30 | 2019-12-31 | No data | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803 |
| G12000011595 | INTEGRATIVE PHYSICAL MEDICINE | EXPIRED | 2012-02-02 | 2017-12-31 | No data | 300 EAST COLONIAL DRIVE, ORLANDO, FL, 32801 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2019-12-13 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L12000112955. MERGER NUMBER 100000198291 |
| LC AMENDMENT | 2016-04-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-05-08 | 2206 EAST COLONIAL DR., ORLANDO, FL 32803 | No data |
| CHANGE OF MAILING ADDRESS | 2013-05-08 | 2206 EAST COLONIAL DR., ORLANDO, FL 32803 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-11 | KABA CONSULTING INC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-11 | 1655 E HWY 50, SUITE 203, CLERMONT, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-03-15 |
| LC Amendment | 2016-04-14 |
| ANNUAL REPORT | 2016-02-24 |
| ANNUAL REPORT | 2015-03-20 |
| ANNUAL REPORT | 2014-04-25 |
| ANNUAL REPORT | 2013-04-11 |
| ANNUAL REPORT | 2012-04-23 |
| Florida Limited Liability | 2011-11-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
