| Entity Name: | MADISON THERAPY & WELLNESS PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Nov 2018 (6 years ago) |
| Document Number: | L18000263547 |
| FEI/EIN Number | 832549908 |
| Mail Address: | 2881 NE OLD BLUE SPRINGS RD, LEE, FL, 32059, US |
| Address: | 235 SW Dade Street, Madison, FL, 32340, US |
| ZIP code: | 32340 |
| County: | Madison |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871062646 | 2018-11-21 | 2021-07-21 | 2881 NE OLD BLUE SPRINGS RD, LEE, FL, 320594539, US | 235 SW DADE ST STE B, MADISON, FL, 323402363, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 850-464-0594 |
| Phone | +1 850-973-2929 |
| Fax | 8509733939 |
Authorized person
| Name | DR. KRISTIN CAMPBELL SEARCY |
| Role | OWNER/ADMINISTRATOR |
| Phone | 8504640594 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102295299 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SEARCY KRISTIN | Agent | 2881 NE OLD BLUE SPRINGS RD, LEE, FL, 32059 |
| Name | Role | Address |
|---|---|---|
| SEARCY KRISTIN | Auth | 2881 NE OLD BLUE SPRINGS RD, LEE, FL, 32059 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-02 | 235 SW Dade Street, Suite #B, Madison, FL 32340 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-08 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-02 |
| Florida Limited Liability | 2018-11-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
