| Entity Name: | FUNCTION HEALTH AND WELLNESS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Aug 2013 (11 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L13000117406 |
| FEI/EIN Number | 463463097 |
| Address: | 916 DELTONA BOULEVARD, DELTONA, FL, 32725, US |
| Mail Address: | 916 DELTONA BOULEVARD, DELTONA, FL, 32725, US |
| ZIP code: | 32725 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386072882 | 2013-10-17 | 2020-02-05 | 829 DELTONA BLVD, SUITE 204, DELTONA, FL, 327257132, US | 829 DELTONA BLVD, SUITE 204, DELTONA, FL, 327257132, US | |||||||||||||||||||||
|
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| Phone | +1 386-259-9838 |
| Fax | 3862599834 |
Authorized person
| Name | SAMUEL LAVARIAS |
| Role | ADMINISTRATOR |
| Phone | 3862599838 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010925600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAVARIAS SAMUEL | Agent | 916 DELTONA BLVD, DELTONA, FL, 32725 |
| Name | Role | Address |
|---|---|---|
| LAVARIAS SAMUEL | Managing Member | 916 DELTONA BLVD STE 104, DELTONA, FL, 32725 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000038689 | PHYSICALTHERAPY.WORKS | ACTIVE | 2021-03-20 | 2026-12-31 | No data | 916 DELTONA BLVD, 104, DELTONA, FL, 32725 |
| G16000114402 | FYZIOTHERAPY | EXPIRED | 2016-10-20 | 2021-12-31 | No data | 829 DELTONA BLVD., STE. 204, DELTONA, FL, 32725 |
| G13000083593 | PAIN CARE & WELLNESS | EXPIRED | 2013-08-22 | 2018-12-31 | No data | 718 BRECKENRIDGE DRIVE, PORT ORANGE, FL, 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-20 | 916 DELTONA BLVD, 104, DELTONA, FL 32725 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-28 | 916 DELTONA BOULEVARD, #104, DELTONA, FL 32725 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-27 | 916 DELTONA BOULEVARD, #104, DELTONA, FL 32725 | No data |
| LC NAME CHANGE | 2015-10-30 | FUNCTION HEALTH AND WELLNESS LLC | No data |
| REINSTATEMENT | 2014-09-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000500528 | ACTIVE | 1000001005621 | VOLUSIA | 2024-08-01 | 2034-08-07 | $ 1,011.85 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, DAYTONA BEACH SERVICE CENTER, 1180 N WILLIAMSON BLVD STE 160, DAYTONA BEACH FL321148179 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-20 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-03-20 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-02-23 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-22 |
| LC Name Change | 2015-10-30 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
