| Entity Name: | RESTORE BRAIN, SPORT AND SPINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jan 2024 (a year ago) |
| Document Number: | L24000030341 |
| Address: | 11603 Sheldon Road, Tampa, FL, 33626, US |
| Mail Address: | 5476 LOCKPORT COURT, PALM HARBOR, FL, 34685, US |
| ZIP code: | 33626 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376378091 | 2024-09-03 | 2024-09-03 | 5476 LOCKPORT CT, PALM HARBOR, FL, 346853644, US | 11603 SHELDON ROAD, TAMPA, FL, 33626, US | |||||||||||||
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| Phone | +1 516-680-8080 |
Authorized person
| Name | DR. THOMAS REILLY |
| Role | CEO |
| Phone | 5166808080 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| REILLY THOMAS | Agent | 5476 LOCKPORT CT, PALM HARBOR, FL, 34685 |
| Name | Role | Address |
|---|---|---|
| REILLY THOMAS | Authorized Member | 5476 LOCKPORT COURT, PALM HARBOR, FL, 34685 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-19 | 11603 Sheldon Road, Tampa, FL 33626 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-01-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
