| Entity Name: | CAPE CORAL INJURY CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Oct 2024 (4 months ago) |
| Document Number: | L24000441126 |
| Address: | 1260 NE 8TH ST. #110, CAPE CORAL, FL, 33909, US |
| Mail Address: | 1260 NE 8TH ST. #110, CAPE CORAL, FL, 33909, US |
| ZIP code: | 33909 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093537854 | 2024-10-31 | 2024-10-31 | 1260 NE 8TH ST STE 110, CAPE CORAL, FL, 339093169, US | 1260 NE 8TH ST STE 110, CAPE CORAL, FL, 339093169, US | |||||||||||||||||||||
|
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| Phone | +1 239-573-7988 |
Authorized person
| Name | ANDREW KAMMERER |
| Role | PART OWNER |
| Phone | 3172247242 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| KING PATRICK | Agent | 1260 NE 8TH ST. #110, CAPE CORAL, FL, 33909 |
| Name | Role |
|---|---|
| PTK MEDICAL, LLC | Manager |
| FORT MYERS CARE LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000143598 | PREMIER MEDICAL GROUP | ACTIVE | 2024-11-25 | 2029-12-31 | No data | 1260 NE 8TH STREET #110, CAPE CORAL, FL, 33909 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-10-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
