| Entity Name: | OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES- ST. PETERSBURG, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Aug 2018 (6 years ago) |
| Document Number: | L18000197200 |
| FEI/EIN Number | 831619760 |
| Address: | 2600 DR MARTIN LUTHER KING JR ST N STE, 200B, ST PETERSBURG, FL, 33704, US |
| Mail Address: | 14004 Roosevelt Blvd, Clearwater, FL, 33762, US |
| ZIP code: | 33704 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073085734 | 2018-12-19 | 2019-12-09 | 21756 STATE ROAD 54 STE 102, LUTZ, FL, 335492905, US | 2600 DR MARTIN LUTHER KING JR ST N STE 200B, ST PETERSBURG, FL, 337042744, US | |||||||||||||||||||||||
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| Phone | +1 727-475-5580 |
| Fax | 8442138986 |
| Phone | +1 727-474-5580 |
Authorized person
| Name | BETH PATTERSON |
| Role | MANAGER |
| Phone | 8136904414 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PT LICENSE |
| Number | PT19911 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MADDOX JEREMY | Agent | 1100 35TH AVE NE, ST PETERSBURG, FL, 33704 |
| Name | Role |
|---|---|
| MADDOX FAMILY, LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-10-16 | 2600 DR MARTIN LUTHER KING JR ST N STE, 200B, ST PETERSBURG, FL 33704 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-01-26 |
| Florida Limited Liability | 2018-08-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
