| Entity Name: | PARK LAKE PHYSICAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PARK LAKE PHYSICAL MEDICINE, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| 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
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 | Address |
|---|---|---|
| INTEGRATIVE PHYSICAL MEDICINE HOLDING, LLC | Manager | 425 ALEXANDRIA BLVD, OVIEDO, FL, 32765 |
| KABA CONSULTING INC. | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000076435 | COMPLETE CARE | EXPIRED | 2019-07-15 | 2024-12-31 | - | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803 |
| G18000083169 | INTEGRATIVE PHYSICAL MEDICINE | EXPIRED | 2018-08-01 | 2023-12-31 | - | 2206 E COLONIAL DR, ORLANDO, FL, 32806 |
| G14000052446 | COLTEN HEALTHCARE MANAGEMENT | EXPIRED | 2014-05-30 | 2019-12-31 | - | 2206 EAST COLONIAL DR., ORLANDO, FL, 32803 |
| G12000011595 | INTEGRATIVE PHYSICAL MEDICINE | EXPIRED | 2012-02-02 | 2017-12-31 | - | 300 EAST COLONIAL DRIVE, ORLANDO, FL, 32801 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2019-12-13 | - | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L12000112955. MERGER NUMBER 100000198291 |
| LC AMENDMENT | 2016-04-14 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2013-05-08 | 2206 EAST COLONIAL DR., ORLANDO, FL 32803 | - |
| CHANGE OF MAILING ADDRESS | 2013-05-08 | 2206 EAST COLONIAL DR., ORLANDO, FL 32803 | - |
| REGISTERED AGENT NAME CHANGED | 2013-04-11 | KABA CONSULTING INC | - |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-11 | 1655 E HWY 50, SUITE 203, CLERMONT, FL 34711 | - |
| 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 Apr 2025
Sources: Florida Department of State
