| Entity Name: | ORTHO INTEGRATIVE MEDICINE INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 2022 (2 years ago) |
| Document Number: | L22000491572 |
| FEI/EIN Number | 88-4369613 |
| Address: | 2574 REDWOOD WAY, CLEARWATER, FL, 33761 |
| Mail Address: | 2574 REDWOOD WAY, CLEARWATER, FL, 33761 |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972379741 | 2023-12-01 | 2023-12-01 | 25749 US HIGHWAY 19 N STE 100, CLEARWATER, FL, 337632004, US | 25749 US HIGHWAY 19 N STE 100, CLEARWATER, FL, 337632004, US | |||||||||||||||||
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| Phone | +1 855-724-6727 |
Authorized person
| Name | DR. EMMETT A. BLAHNIK |
| Role | OWNER |
| Phone | 6083588455 |
Taxonomy
| Taxonomy Code | 202D00000X - Integrative Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2081N0008X - Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MUSTARI JEFFREY | Agent | 301 W. BAY STREET, JACKSONVILLE, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| BLAHNIK EMMETT | Authorized Member | 2574 REDWOOD WAY, CLEARWATER, FL, 33761 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-30 |
| Florida Limited Liability | 2022-11-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
