| Entity Name: | CARROLLWOOD SPEECH AND SWALLOWING THERAPY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 10 Nov 2017 (7 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L17000233492 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 14502 N DALE MABRY HWY STE 200, TAMPA, FL, 33618, US |
| Mail Address: | 14502 N DALE MABRY HWY STE 200, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366958977 | 2017-12-19 | 2018-06-16 | 14502 N DALE MABRY HWY STE 200, TAMPA, FL, 336182040, US | 14502 N DALE MABRY HWY STE 200, TAMPA, FL, 336182040, US | |||||||||||||||||||||||||
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| Phone | +1 813-812-4463 |
Authorized person
| Name | TIMOTHY STOCKDALE |
| Role | OWNER |
| Phone | 8138124463 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 4TM44 |
| State | FL |
| Issuer | MEDICAID |
| Number | 018980200 |
| State | FL |
| Name | Role |
|---|---|
| LEGALINC CORPORATE SERVICES INC. | Agent |
| Name | Role | Address |
|---|---|---|
| STOCKDALE TIMOTHY | Authorized Member | 2306 TOWERY TRL, LUTZ, FL, 33549 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-10 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-30 | 14502 N DALE MABRY HWY STE 200, TAMPA, FL 33618 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-30 | 14502 N DALE MABRY HWY STE 200, TAMPA, FL 33618 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-30 |
| Florida Limited Liability | 2017-11-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
