| Entity Name: | SOUTH FLORIDA PHYSIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Mar 2017 (8 years ago) |
| Document Number: | L17000050062 |
| FEI/EIN Number | 820751822 |
| Address: | 1755 SW 12TH ST, MIAMI, FL, 33135, US |
| Mail Address: | 1755 SW 12TH ST, MIAMI, FL, 33135, US |
| ZIP code: | 33135 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285175125 | 2017-03-11 | 2024-04-04 | 1755 SW 12TH ST, MIAMI, FL, 331355115, US | 47 NW 32ND PL, MIAMI, FL, 331254914, US | |||||||||||||||||||||
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| Phone | +1 305-677-3541 |
| Fax | 8889298436 |
| Phone | +1 305-487-3040 |
Authorized person
| Name | CARLA M VELEZ-COUTO |
| Role | MGR |
| Phone | 3054873040 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME110485 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VELEZ-COUTO CARLA M | Agent | 1755 SW 12TH ST, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| VELEZ-COUTO CARLA M | Manager | 1755 SW 12TH ST, MIAMI, FL, 33135 |
| VASQUEZ-DUARTE RICARDO J | Manager | 1755 SW 12TH ST, MIAMI, FL, 33135 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000034852 | SPORTS MEDICINE GROUP | EXPIRED | 2017-04-01 | 2022-12-31 | No data | 1755 SW 12TH ST, MIAMI, FL, 33135 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-04-01 |
| Florida Limited Liability | 2017-03-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
