| Entity Name: | ACTIVE FOR LIFE REHABILITATION, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Feb 2013 (12 years ago) |
| Document Number: | L13000027036 |
| FEI/EIN Number | 46-2027462 |
| Address: | 4164 LONICERA LOOP, ST. JOHNS, FL, 32259 |
| Mail Address: | 4164 LONICERA LOOP, ST. JOHNS, FL, 32259 |
| ZIP code: | 32259 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639410384 | 2013-03-05 | 2014-07-21 | 4164 LONICERA LOOP, SAINT JOHNS, FL, 322594531, US | 4164 LONICERA LOOP, SAINT JOHNS, FL, 322594531, US | |||||||||||||||||||||||||
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| Phone | +1 904-891-1179 |
| Fax | 9042121202 |
Authorized person
| Name | DR. GEOFFREY GRAEME ANGELL |
| Role | MANAGER |
| Phone | 9048911179 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT 21700 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010501000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ANGELL GEOFFREY | Agent | 4164 LONICERA LOOP, ST. JOHNS, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| ANGELL GEOFFREY | Managing Member | 4164 LONICERA LOOP, ST. JOHNS, FL, 32259 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-05-12 |
| ANNUAL REPORT | 2019-04-28 |
| ANNUAL REPORT | 2018-04-15 |
| ANNUAL REPORT | 2017-04-08 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
