| Entity Name: | TAMPA BAY PHYSICAL THERAPY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 25 Aug 2021 (3 years ago) |
| Document Number: | L21000380640 |
| FEI/EIN Number | 87-2129185 |
| Address: | 20110 Blue daze Ave, Tampa, FL 33647 |
| Mail Address: | 20110 BLUE DAZE AVE, TAMPA, FL 33647 |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841966520 | 2021-08-21 | 2022-05-02 | 20110 BLUE DAZE AVE, TAMPA, FL, 336472965, US | 13328 TELECOM DR, TEMPLE TERRACE, FL, 336370938, US | |||||||||||||
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| Phone | +1 352-426-1751 |
Authorized person
| Name | KELLY BROOKE PEARCE BAEZ |
| Role | PHYSICAL THERAPIST |
| Phone | 3524261751 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PEARCE BAEZ, KELLY B | Agent | 20110 BLUE DAZE AVE, TAMPA, FL 33647 |
| Name | Role | Address |
|---|---|---|
| PEARCE BAEZ, KELLY B | Manager | 20110 BLUE DAZE AVE, TAMPA, FL 33647 |
| BAEZ, JOEL H | Manager | 20110 BLUE DAZE AVE, TAMPA, FL 33647 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000147963 | TAMPA BAY PT | ACTIVE | 2021-11-04 | 2026-12-31 | No data | 13328 TELECOM DRIVE, TEMPLE TERRACE, FL, 33637 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-30 | 20110 Blue daze Ave, Tampa, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-30 |
| Florida Limited Liability | 2021-08-25 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
