| Entity Name: | COUNTRY CLUB PHYSICAL THERAPY, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Aug 2012 (12 years ago) |
| Document Number: | L12000112512 |
| FEI/EIN Number | 46-0910639 |
| Address: | 14529 INDIGO LAKES CIRCLE, NAPLES, FL, 34119 |
| Mail Address: | 14529 INDIGO LAKES CIRCLE, NAPLES, FL, 34119 |
| ZIP code: | 34119 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659616944 | 2012-11-28 | 2012-11-28 | PO BOX 8838, NAPLES, FL, 341018838, US | 14529 INDIGO LAKES CIR, NAPLES, FL, 341194811, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 239-280-1229 |
Authorized person
| Name | PHILIP CROMBIE |
| Role | PHYSICAL THERAPIST/OWNER |
| Phone | 2392801229 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT11581 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA PHYSICAL THERAPY LICENSE |
| Number | PT11581 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CROMBIE PHILIP P | Agent | 14529 INDIGO LAKES CIRCLE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| CROMBIE PHILIP P | Managing Member | 14529 INDIGO LAKES CIRCLE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| CROMBIE MICHELLE A | Manager | 14529 INDIGO LAKES CIRCLE, NAPLES, FL, 34119 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-01-24 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-02-03 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-01-18 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-01-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
