| Entity Name: | JUDO RYU JACKSONVILLE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Aug 2001 (24 years ago) |
| Document Number: | P01000076621 |
| FEI/EIN Number | 593742342 |
| Address: | 691 SELVA LAKES CIR., ATLANTIC BEACH, FL, 32233, US |
| Mail Address: | 691 SELVA LAKES CIR., ATLANTIC BEACH, FL, 32233, US |
| ZIP code: | 32233 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982893509 | 2007-10-19 | 2008-04-20 | 691 SELVA LAKES CIR, ATLANTIC BEACH, FL, 322337326, US | 1241 MAYPORT RD, ATLANTIC BEACH, FL, 322333435, US | |||||||||||||||||||||||||
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| Phone | +1 904-349-0990 |
| Fax | 8667371635 |
Authorized person
| Name | SUSAN MANCHESTER |
| Role | BILLING AGENT |
| Phone | 9047775002 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT7180 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS OF FLORIDA |
| Number | Y4214 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BANKSTON JEFFREY R | Agent | 2215 S. THIRD ST., STE. 101, JACKSONVILLE BEACH, FL, 32250 |
| Name | Role | Address |
|---|---|---|
| FIEGE JOHN C | Director | 691 SELVA LAKES CIR., ATLANTIC BEACH, FL, 32233 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-03-20 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
