| Entity Name: | SUNCOAST PHYSICAL MEDICINE OF NORTH TAMPA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 May 2021 (4 years ago) |
| Document Number: | L21000225367 |
| FEI/EIN Number | 88-1888964 |
| Address: | 3010 E 138th Ave, TAMPA, FL, 33613, US |
| Mail Address: | 3010 E 138th Ave, TAMPA, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831806561 | 2022-11-02 | 2022-11-02 | 3450 E FLETCHER AVE STE 320, TAMPA, FL, 336134659, US | 3450 E FLETCHER AVE STE 320, TAMPA, FL, 336134659, US | |||||||||||||||||||||||||||
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| Phone | +1 813-668-0000 |
| Fax | 8136680978 |
Authorized person
| Name | JASMINE QUINTANA |
| Role | OFFICE MANAGER |
| Phone | 8139060000 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BERNS JONATHAN DC | Agent | 3450 E FLETCHER AVE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| BERNS JONATHAN DC | Manager | 3450 E FLETCHER AVE, STE 320, TAMPA, FL, 33613 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000064700 | SPINEMED | ACTIVE | 2024-05-20 | 2029-12-31 | No data | 701 W DR MARTIN LUTHER KING JR BLVD, STE 4, TAMPA, FL, 33603 |
| G23000126152 | PAINMED | ACTIVE | 2023-10-11 | 2028-12-31 | No data | 3450 E FLETCHER AVE, STE 320, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-13 | 3010 E 138th Ave, TAMPA, FL 33613 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-13 | 3010 E 138th Ave, TAMPA, FL 33613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-03-26 |
| ANNUAL REPORT | 2022-04-20 |
| Florida Limited Liability | 2021-05-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
