| Entity Name: | PAIN AND SPINE PHYSIO REHAB LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 May 2014 (11 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L14000076992 |
| FEI/EIN Number | 46-5656020 |
| Address: | 100 SOUTHPARK BLVD STE 408 B, SAINT AUGUSTINE, FL, 32086, US |
| Mail Address: | 100 SOUTHPARK BLVD STE 408 B, SAINT AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073918371 | 2014-10-29 | 2015-03-24 | 100 SOUTHPARK BLVD, SUITE 408-B, ST AUGUSTINE, FL, 320865189, US | 100 SOUTHPARK BLVD, SUITE 408 B, ST AUGUSTINE, FL, 320865189, US | |||||||||||||||||||||||||
|
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| Phone | +1 518-407-3422 |
Authorized person
| Name | MR. REGINO IRWIN B REYES |
| Role | AMBR |
| Phone | 5184073422 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT7862 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| License Number | PT0007862 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| REYES REGINO IRWIN B | Authorized Member | 100 SOUTHPARK BLVD STE 408 B, SAINT AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-22 | 100 SOUTHPARK BLVD STE 408 B, SAINT AUGUSTINE, FL 32086 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-22 | 100 SOUTHPARK BLVD STE 408 B, SAINT AUGUSTINE, FL 32086 | No data |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2017-11-21 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-22 |
| Florida Limited Liability | 2014-05-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
