| Entity Name: | ELITE REHABILITATION AND PAIN MANAGEMENT LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Jul 2017 (8 years ago) |
| Document Number: | L17000150409 |
| FEI/EIN Number | 82-2180652 |
| Address: | 1151 Skye lane, PALM HARBOR, FL 34683 |
| Mail Address: | 1151 skye lane, PALM HARBOR, FL 34683 |
| ZIP code: | 34683 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942724059 | 2017-07-31 | 2018-01-24 | 1029 ROUNDSTONE PL, PALM HARBOR, FL, 346831462, US | 901 CLEARWATER LARGO RD N, LARGO, FL, 337704126, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 727-586-2999 |
Authorized person
| Name | STEPHANIE WEBB |
| Role | OWNER |
| Phone | 9149241494 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | OS14566 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | OS14566 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | R25Y9 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EVERLOVE-STONE, KATIE | Agent | 1700 66TH STREET NORTH, SUITE 206, SAINT PETERSBURG, FL 33710 |
| Name | Role | Address |
|---|---|---|
| Webb, Stephanie | Manager | 1151 SKYE LN, PALM HARBOR, FL 34683 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-03 | 1151 Skye lane, PALM HARBOR, FL 34683 | No data |
| CHANGE OF MAILING ADDRESS | 2020-08-04 | 1151 Skye lane, PALM HARBOR, FL 34683 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-03-29 |
| Florida Limited Liability | 2017-07-13 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
