| Entity Name: | OUTPATIENT PAIN AND WELLNESS CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Jul 2001 (24 years ago) |
| Date of dissolution: | 16 Jan 2019 (6 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 16 Jan 2019 (6 years ago) |
| Document Number: | P01000075794 |
| FEI/EIN Number | 311801439 |
| Address: | 4620 N Habana Ave, suite 203, TAMPA, FL, 33614, US |
| Mail Address: | 4620 N Habana Ave, suite 203, TAMPA, FL, 33614, US |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184861148 | 2009-01-13 | 2009-01-13 | 4602 N ARMENIA AVE, SUITE B5, TAMPA, FL, 336032626, US | 4602 N ARMENIA AVE, SUITE B5, TAMPA, FL, 336032626, US | |||||||||||||||||||||||||
|
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| Phone | +1 813-874-6600 |
| Fax | 8138746601 |
Authorized person
| Name | DR. KATHLEEN CLEMENTS |
| Role | PRESIDENT |
| Phone | 8138746600 |
Taxonomy
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| License Number | CH7977 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 382225700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEOTTA SEAN | Agent | 11437 WATERSTONE LOOP DRIVE, WINDERMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| LEOTTA KATHLEEN | President | 11437 Waterstone Loop Dr, Windermere, FL, 34786 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000075748 | OUTPATIENT PAIN AND WELLNESS CENTER | EXPIRED | 2015-07-21 | 2020-12-31 | No data | 4602 N ARMENIA AVE B-5, TAMPA, FL, 33603 |
| G08303900196 | OUTPATIENT PAIN & WELLNESS CENTER | EXPIRED | 2008-10-29 | 2013-12-31 | No data | 4602 NORTH ARMENIA AVENUE, SUITE B-4, TAMPA, FL, 33603 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2019-01-16 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS P05000030055. MERGER NUMBER 100000189611 |
| CHANGE OF MAILING ADDRESS | 2018-04-08 | 4620 N Habana Ave, suite 203, TAMPA, FL 33614 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-08 | 4620 N Habana Ave, suite 203, TAMPA, FL 33614 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-12-18 | 11437 WATERSTONE LOOP DRIVE, WINDERMERE, FL 34786 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-16 | LEOTTA, SEAN | No data |
| AMENDMENT | 2009-09-22 | No data | No data |
| REINSTATEMENT | 2003-12-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| NAME CHANGE AMENDMENT | 2002-06-13 | OUTPATIENT PAIN AND WELLNESS CENTER, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-08 |
| ANNUAL REPORT | 2017-03-16 |
| Reg. Agent Change | 2017-03-16 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-03-24 |
| ANNUAL REPORT | 2014-02-26 |
| ANNUAL REPORT | 2013-04-08 |
| ANNUAL REPORT | 2012-03-28 |
| ANNUAL REPORT | 2011-02-07 |
| ANNUAL REPORT | 2010-01-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
