| Entity Name: | FORWARD LIVING THERAPY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Mar 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 Jun 2021 (4 years ago) |
| Document Number: | L21000140007 |
| FEI/EIN Number | 86-3143094 |
| Address: | 4600 SUMMERLIN RD., C-2272, FORT MYERS, FL, 33919, US |
| Mail Address: | 4600 SUMMERLIN RD., C-2272, FORT MYERS, FL, 33919, US |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487234068 | 2021-04-08 | 2023-01-18 | 4600 SUMMERLIN RD, # C-2272, FORT MYERS, FL, 339193005, US | 4600 SUMMERLIN RD, # C-2272, FORT MYERS, FL, 339193005, US | |||||||||||||||||||||
|
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| Phone | +1 239-266-5362 |
Authorized person
| Name | DR. JESSICA A CHAPMAN |
| Role | REGISTERED AGENT/OWNER |
| Phone | 2392665362 |
Taxonomy
| Taxonomy Code | 224Z00000X - Occupational Therapy Assistant |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CHAPMAN JESSICA | Agent | 4600 SUMMERLIN RD., FORT MYERS, FL, 33919 |
| Name | Role | Address |
|---|---|---|
| MILLER-CHAPMAN BRANDY | Authorized Representative | 4600 SUMMERLIN RD. C-2272, FORT MYERS, FL, 33919 |
| CHAPMAN JESSICA | Authorized Representative | 4600 SUMMERLIN RD, FORT MYERS, FL, 33919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-06-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-01-26 |
| LC Amendment | 2021-06-21 |
| Florida Limited Liability | 2021-03-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
