| Entity Name: | FLORIDA MOVEMENT THERAPY CENTER - BOCA RATON, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 May 2012 (13 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 02 Jun 2016 (9 years ago) |
| Document Number: | L12000063562 |
| FEI/EIN Number | 455264282 |
| Address: | 21345 POWERLINE ROAD,, STE 100, BOCA RATON, FL, 33433, US |
| Mail Address: | 12040 S JOG ROAD, BOYNTON BEACH, FL, 33437, US |
| ZIP code: | 33433 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407118268 | 2012-06-07 | 2016-07-07 | 21065 POWERLINE RD, SUITE A2, BOCA RATON, FL, 334332313, US | 21065 POWERLINE RD, SUITE A2, BOCA RATON, FL, 334332313, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-883-7800 |
| Fax | 5618837801 |
Authorized person
| Name | JODI GRAY |
| Role | VICE PRESIDENT |
| Phone | 5618837800 |
Taxonomy
| Taxonomy Code | 2251G0304X - Geriatric Physical Therapist |
| License Number | PT3436 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225XN1300X - Neurorehabilitation Occupational Therapist |
| License Number | OT9734 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA5535 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | GL290A |
| Name | Role | Address |
|---|---|---|
| Levkovich David | Agent | 12040 S JOG ROAD, BOYNTON BEACH, FL, 33437 |
| Name | Role | Address |
|---|---|---|
| Levkovich David | Manager | 12040 S JOG ROAD, BOYNTON BEACH, FL, 33437 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-26 | 21345 POWERLINE ROAD,, STE 100, BOCA RATON, FL 33433 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-02-26 | Levkovich, David | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-26 | 12040 S JOG ROAD, SUITE #7, BOYNTON BEACH, FL 33437 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-24 | 21345 POWERLINE ROAD,, STE 100, BOCA RATON, FL 33433 | No data |
| LC AMENDMENT AND NAME CHANGE | 2016-06-02 | FLORIDA MOVEMENT THERAPY CENTER - BOCA RATON, LLC | No data |
| LC AMENDMENT | 2012-06-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-02-17 |
| ANNUAL REPORT | 2020-03-11 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-04-03 |
| LC Amendment and Name Change | 2016-06-02 |
| ANNUAL REPORT | 2016-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
