| Entity Name: | PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 May 2023 (2 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 Oct 2024 (4 months ago) |
| Document Number: | L23000231887 |
| FEI/EIN Number | 33-1316283 |
| Mail Address: | 301 SW 1ST AVE, 2019, FORT LAUDERDALE, FL, 33301, US |
| Address: | 3800 WEST BROWARD BLVD, 101, RM 8, PLANTATION, FL, 33312 |
| ZIP code: | 33312 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750100723 | 2024-10-07 | 2024-10-14 | 3800 W BROWARD BLVD STE 101, FT LAUDERDALE, FL, 333121018, US | 3800 W BROWARD BLVD STE 101, FT LAUDERDALE, FL, 333121018, US | |||||||||||||||||
|
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| Phone | +1 954-787-5234 |
| Fax | 9548204479 |
| Phone | +1 469-915-4211 |
Authorized person
| Name | EMIR KHATTAK |
| Role | CREDENTIALING MANAGER |
| Phone | 4694853166 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ODAZIE HENRY | Agent | 301 SW 1ST AVE, FORT LAUDERDALE, FL, 33301 |
| Name | Role | Address |
|---|---|---|
| ODAZIE HENRY | Manager | 301 SW 1ST AVE, 2019, FL, 33301 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-10-11 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-10-11 | ODAZIE, HENRY | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-10-11 |
| Florida Limited Liability | 2023-05-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
