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  5. PEDIATRIC THERAPY SERVICES, INC.

PEDIATRIC THERAPY SERVICES, INC.

Company Details

Entity Name: PEDIATRIC THERAPY SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 15 Dec 1989 (35 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 11 Apr 2020 (5 years ago)
Document Number: L36775
FEI/EIN Number 59-2984541
Address: 1215 E ORANGE ST, LAKELAND, FL 33801
Mail Address: 1215 E ORANGE ST, LAKELAND, FL 33801
ZIP code: 33801
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1871769349 2008-05-05 2018-08-20 206 RIDGEWOOD AVE, BRANDON, FL, 335104617, US 206 RIDGEWOOD AVE, BRANDON, FL, 33510, US

Contacts
Phone +1 813-662-1060
Fax 8136620530

Authorized person
Name GRAHAM KILBURN
Role OWNER/PRESIDENT
Phone 8136621060

Taxonomy
Taxonomy Code 2251P0200X - Pediatric Physical Therapist
License Number PT5990
State FL
Is Primary No
Taxonomy Code 225XP0200X - Pediatric Occupational Therapist
License Number OT1478
State FL
Is Primary No
Taxonomy Code 235Z00000X - Speech-Language Pathologist
License Number SA7398
State FL
Is Primary No
Taxonomy Code 261Q00000X - Clinic/Center
Is Primary Yes
Taxonomy Code 332BC3200X - Customized Equipment (DME)
License Number PT2549
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 024393800
State FL
Issuer UNITED HEALTHCARE
Number 6406221
State FL
Issuer MEDICAID
Number 8803579-04
State FL
Issuer CIGNA
Number 8810363001
State FL
Issuer BLUE CROSS BLUE SHIELD
Number Y906F
State FL
Issuer AETNA
Number 664175
State FL
Issuer CITRUS COMMERCIAL/HMO
Number 13424302
State FL
Issuer MEDICAID
Number 8803579-01
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2023 592984541 2024-04-25 PEDIATRIC THERAPY SERVICES, INC. 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2022 592984541 2023-03-02 PEDIATRIC THERAPY SERVICES, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2021 592984541 2022-09-20 PEDIATRIC THERAPY SERVICES, INC. 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2020 592984541 2021-07-07 PEDIATRIC THERAPY SERVICES, INC. 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2019 592984541 2020-05-29 PEDIATRIC THERAPY SERVICES, INC. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2018 592984541 2019-05-03 PEDIATRIC THERAPY SERVICES, INC. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2017 592984541 2018-03-08 PEDIATRIC THERAPY SERVICES, INC. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2016 592984541 2017-03-03 PEDIATRIC THERAPY SERVICES, INC. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET LAKELAND, LAKELAND, FL, 338017562
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 592984541 2016-02-25 PEDIATRIC THERAPY SERVICES, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET LAKELAND, LAKELAND, FL, 338017562

Signature of
Role Plan administrator
Date 2016-02-25
Name of individual signing KATHY SHUFFLEBARGER
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC THERAPY SERVICES, INC. 401(K) PROFIT SHARING PLAN 2014 592984541 2015-07-23 PEDIATRIC THERAPY SERVICES, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621340
Sponsor’s telephone number 8638023800
Plan sponsor’s address 1215 EAST ORANGE STREET, LAKELAND, FL, 338017562

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing KATHY SHUFFLEBARGER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Kilburn, Graham Agent 1215 E. Orange Street, LAKELAND, FL 33801

President

Name Role Address
Kilburn, Graham President 1215 E ORANGE ST, LAKELAND, FL 33801

Director

Name Role Address
Kilburn, Graham Director 1215 E ORANGE ST, LAKELAND, FL 33801
Riva, Diana Director 1215 E ORANGE ST, LAKELAND, FL 33801

Treasurer

Name Role Address
Kilburn, Graham Treasurer 1215 E ORANGE ST, LAKELAND, FL 33801

Vice President

Name Role Address
Riva, Diana Vice President 1215 E ORANGE ST, LAKELAND, FL 33801

Secretary

Name Role Address
Riva, Diana Secretary 1215 E ORANGE ST, LAKELAND, FL 33801

Events

Event Type Filed Date Value Description
REINSTATEMENT 2020-04-11 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
REGISTERED AGENT NAME CHANGED 2016-02-29 Kilburn, Graham No data
REGISTERED AGENT ADDRESS CHANGED 2016-02-29 1215 E. Orange Street, LAKELAND, FL 33801 No data
CHANGE OF PRINCIPAL ADDRESS 2002-03-25 1215 E ORANGE ST, LAKELAND, FL 33801 No data
CHANGE OF MAILING ADDRESS 2002-03-25 1215 E ORANGE ST, LAKELAND, FL 33801 No data

Documents

Name Date
ANNUAL REPORT 2024-02-22
ANNUAL REPORT 2023-01-25
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-02-16
REINSTATEMENT 2020-04-11
ANNUAL REPORT 2018-01-22
ANNUAL REPORT 2017-02-09
ANNUAL REPORT 2016-02-29
ANNUAL REPORT 2015-01-26
ANNUAL REPORT 2014-01-09

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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