| Entity Name: | NEXT PHASE MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 31 Jan 2019 (6 years ago) |
| Document Number: | L19000032372 |
| FEI/EIN Number | 83-3509141 |
| Address: | 3690 East Bay Drive South, Suite S, Largo, FL 33771 |
| Mail Address: | 200 Biddle Ave, Suite 203, Newark, DE 19702 |
| ZIP code: | 33771 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912469099 | 2019-04-05 | 2020-03-11 | 3690 E BAY DR STE S, LARGO, FL, 337711946, US | 3690 E BAY DR STE S, LARGO, FL, 337711946, US | |||||||||||||||||||||||||
|
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| Phone | +1 727-275-7668 |
| Fax | 7272758427 |
Authorized person
| Name | DEBRA WITTLES |
| Role | ADMINISTRATOR |
| Phone | 7272757668 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | PT19324 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Speciale, Daniel | Agent | 3690 East Bay Drive South, Suite S, Largo, FL 33771 |
| Name | Role | Address |
|---|---|---|
| Speciale, Daniel | Owner | 3690 East Bay Drive South, Suite S Largo, FL 33771 |
| Name | Role | Address |
|---|---|---|
| Hewlett, Christopher R, Sr. | Chief Financial Officer | PO Box 1643, Hockessin, DE 19707 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000023072 | PHYSICAL THERAPY NOW LARGO | EXPIRED | 2019-02-15 | 2024-12-31 | No data | 3690 EAST BAY DR. SUITE S, LARGO, FL, 33771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-01-17 | 3690 East Bay Drive South, Suite S, Largo, FL 33771 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-17 | 3690 East Bay Drive South, Suite S, Largo, FL 33771 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-07-17 | Speciale, Daniel | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-07-17 | 3690 East Bay Drive South, Suite S, Largo, FL 33771 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-07-17 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-01-14 |
| Florida Limited Liability | 2019-01-31 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
