| Entity Name: | NORTHWOOD SPORTS MEDICINE AND PHYSICAL REHABILITATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 19 Feb 1988 (37 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 08 Aug 1988 (37 years ago) |
| Document Number: | M69584 |
| FEI/EIN Number | 65-0045944 |
| Address: | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 |
| Mail Address: | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 |
| ZIP code: | 33409 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003037474 | 2007-05-01 | 2011-10-11 | 2790 N MILITARY TRL, SUITE 1, WEST PALM BEACH, FL, 334092926, US | 2790 N MILITARY TRL, SUITE 1, WEST PALM BEACH, FL, 334092926, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-683-4971 |
| Fax | 5614784946 |
Authorized person
| Name | DR. DAVID B ANDERSON |
| Role | OWNER |
| Phone | 5616834971 |
Taxonomy
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| License Number | CH6427 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| License Number | CH1504 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381442400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Anderson, David B | Agent | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 |
| Name | Role | Address |
|---|---|---|
| ANDERSON, DAVID B, Dr. | Director | 2790 N. MILITARY TRAIL, SUITE #1 WEST PALM BEACH, FL 33409 |
| Name | Role | Address |
|---|---|---|
| ANDERSON, DAVID B, Dr. | President | 2790 N. MILITARY TRAIL, SUITE #1 WEST PALM BEACH, FL 33409 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-02-10 | Anderson, David B | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-10 | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-19 | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-09 | 2790 N. MILITARY TRAIL, SUITE #1, WEST PALM BEACH, FL 33409 | No data |
| AMENDMENT | 1988-08-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-02-10 |
| Reg. Agent Resignation | 2022-11-08 |
| ANNUAL REPORT | 2022-04-09 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-07-01 |
| ANNUAL REPORT | 2016-03-07 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
