| Entity Name: | INTEGRA THERAPEUTIC MASSAGE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Nov 2019 (5 years ago) |
| Document Number: | L19000281507 |
| FEI/EIN Number | 84-3881197 |
| Address: | 2425 DUNN AVENUE, SUITE 1, JACKSONVILLE, FL, 32218, US |
| Mail Address: | 2425 DUNN AVENUE, SUITE 1, JACKSONVILLE, FL, 32082, US |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376159178 | 2020-09-17 | 2020-09-18 | 8257 SEVEN MILE DR, PONTE VEDRA BEACH, FL, 320823132, US | 1871 WELLS RD STE 300, ORANGE PARK, FL, 320732350, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-612-4588 |
| Fax | 9042603011 |
Authorized person
| Name | MS. DARLENE TAN |
| Role | ADMINISTRATOR |
| Phone | 9046124588 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE OF FLORIDA DEPARTMENT OF HEALTH |
| Number | PT10897 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1174800221 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1285070532 |
| State | FL |
| Issuer | STATE OF FLORIDA DEPARTMENT OF HEALTH |
| Number | PT6934 |
| State | FL |
| Issuer | STATE OF FLORIDA DEPARTMENT OF HEALTH |
| Number | PT8535 |
| State | FL |
| Issuer | STATE OF FLORIDA DEPARTMENT OF HEALTH |
| Number | PTA27875 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TAN DARLENE | Agent | 2425 DUNN AVENUE, JACKSONVILLE, FL, 32218 |
| Name | Role | Address |
|---|---|---|
| TAN DARLENE | Manager | 2425 DUNN AVENUE, JACKSONVILLE, FL, 32218 |
| Name | Role | Address |
|---|---|---|
| TAN LAWRENCE | Secretary | 2425 DUNN AVENUE, JACKSONVILLE, FL, 32218 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000051532 | INTEGRACANNA | ACTIVE | 2022-04-22 | 2027-12-31 | No data | 2425 DUNN AVENUE, SUITE 1, JACKSONVILLE, FL, 32218 |
| G20000122135 | INTEGRA PHYSICAL THERAPY AND MASSAGE | ACTIVE | 2020-09-19 | 2025-12-31 | No data | 2425 DUNN AVENUE, SUITE 1, JACKSONVILLE, FL, 32218 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-05-02 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-29 |
| Florida Limited Liability | 2019-11-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
