| Entity Name: | PERFORMANCE PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 14 Apr 2000 (25 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P00000039374 |
| FEI/EIN Number | 593643610 |
| Address: | 150 SOUTHPARK BLVD. SUITE 201, SAINT AUGUSTINE, FL, 32086, US |
| Mail Address: | 150 SOUTHPARK BLVD. SUITE 201, SAINT AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871694919 | 2006-09-25 | 2009-01-15 | 150 SOUTHPARK BLVD, SUITE 201, ST AUGUSTINE, FL, 320865190, US | 150 SOUTHPARK BLVD, SUITE 201, ST AUGUSTINE, FL, 320865190, US | |||||||||||||||||||||||
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| Phone | +1 904-824-7787 |
| Fax | 9044290318 |
Authorized person
| Name | MS. KAREN L HASELTINE |
| Role | C.E.O. |
| Phone | 9048247787 |
Taxonomy
| Taxonomy Code | 2251X0800X - Orthopedic Physical Therapist |
| License Number | PT21013 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | QV9 |
| Name | Role |
|---|---|
| HALL & EDWARDS, PA | Agent |
| Name | Role | Address |
|---|---|---|
| HASELTINE KAREN L | Chief Executive Officer | 150 SOUTHPARK BLVD., SUITE 201, SAINT AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-30 | HALL & EDWARDS, PA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-30 | 3791 A1A SOUTH, SUITE B, ST. AUGUSTINE, FL 32080 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-06-03 | 150 SOUTHPARK BLVD. SUITE 201, SAINT AUGUSTINE, FL 32086 | No data |
| CHANGE OF MAILING ADDRESS | 2008-06-03 | 150 SOUTHPARK BLVD. SUITE 201, SAINT AUGUSTINE, FL 32086 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000202796 | ACTIVE | 1000000782968 | ST JOHNS | 2018-05-17 | 2028-05-23 | $ 757.92 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-05-15 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-04-24 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-12 |
| ANNUAL REPORT | 2012-04-27 |
| ANNUAL REPORT | 2011-04-22 |
| ANNUAL REPORT | 2010-04-23 |
| ANNUAL REPORT | 2009-04-29 |
| ANNUAL REPORT | 2008-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
