| Entity Name: | INTEGRATED MEDICAL THERAPY GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 May 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 16 Sep 2024 (5 months ago) |
| Document Number: | L22000231551 |
| FEI/EIN Number | 88-2556077 |
| Address: | 7901 4th St N, STE 300, St. Petersburg, FL, 33702, US |
| Mail Address: | 7901 4th St N, STE 300, St. Petersburg, FL, 33702, US |
| ZIP code: | 33702 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669488334 | 2006-08-01 | 2023-11-29 | 3745 11TH CIR STE 108, VERO BEACH, FL, 329604838, US | 3745 11TH CIR STE 108, VERO BEACH, FL, 329604838, US | |||||||||||||||||||||
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| Phone | +1 772-567-1552 |
| Fax | 7725675269 |
Authorized person
| Name | MRS. KIM KREBS |
| Role | OFFICE MANAGER/BILLING SPECIALIST |
| Phone | 7725671552 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | NPK0N |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| Sepulveda Arleene | Auth | 7901 4th St N STE 300, St. Petersburg, FL, 33702 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000129860 | TREASURE COAST PEDIATRICS | ACTIVE | 2023-10-20 | 2028-12-31 | No data | 7901 4TH ST N STE 300, ST. PETERSBURG, FL, 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-09-16 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-16 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-13 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-13 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| LC AMENDMENT | 2022-12-08 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-04 | REGISTERED AGENTS INC | No data |
| LC STMNT OF RA/RO CHG | 2022-10-04 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-09-16 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-02-13 |
| LC Amendment | 2022-12-08 |
| CORLCRACHG | 2022-10-04 |
| Florida Limited Liability | 2022-05-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
