| Entity Name: | USA SPORTS MEDICINE MIAMI LAKES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Apr 2022 (3 years ago) |
| Document Number: | L22000176815 |
| FEI/EIN Number | 88-2368613 |
| Address: | 16200 NW 59th Ave, SUITE 107, MIAMI LAKES, FL, 33014, US |
| Mail Address: | 16200 NW 59th Ave, SUITE 107, MIAMI LAKES, FL, 33014, US |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174262224 | 2022-05-27 | 2022-05-27 | 404 WASHINGTON AVE STE 120, MIAMI BEACH, FL, 331396651, US | 16200 NW 57TH AVE STE 107, MIAMI LAKES, FL, 330146714, US | |||||||||||||||||||
|
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| Phone | +1 305-479-2973 |
| Fax | 3057357662 |
Authorized person
| Name | PATTY WARE |
| Role | MANAGER |
| Phone | 3054792973 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Valdes Stefan MGR | Agent | 16200 NW 59th Ave, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| VALDES STEFAN | Manager | 16200 NW 59th Ave, MIAMI LAKES, FL, 33014 |
| Colls Zachary | Manager | 16200 NW 59th Ave, MIAMI LAKES, FL, 33014 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000129673 | MOVEMENT LAB SPORTS MEDICINE | ACTIVE | 2024-10-22 | 2029-12-31 | No data | 16200 NW 59TH AVE, STE 107, MIAMI LAKES, FL, 33014 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-12 | 16200 NW 59th Ave, SUITE 107, MIAMI LAKES, FL 33014 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-12 | 16200 NW 59th Ave, SUITE 107, MIAMI LAKES, FL 33014 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-12 | Valdes, Stefan, MGR | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-12 | 16200 NW 59th Ave, SUITE 107, MIAMI LAKES, FL 33014 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-04-12 |
| Florida Limited Liability | 2022-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
