| Entity Name: | MED DIAGNOSTIC REHAB OF SOUTH FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Sep 2002 (22 years ago) |
| Document Number: | P02000104546 |
| FEI/EIN Number | 113654326 |
| Address: | 1085 KANE CONCOURSE, BAY HARBOR ISLAND, FL, 33154 |
| Mail Address: | 1085 KANE CONCOURSE, BAY HARBOR ISLAND, FL, 33154 |
| ZIP code: | 33154 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588987069 | 2010-03-11 | 2010-03-11 | 8188 JOG RD, SUITE 102, BOYNTON BEACH, FL, 334722952, US | 8188 JOG RD, SUITE 102, BOYNTON BEACH, FL, 334722952, US | |||||||||||||||||||||
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| Phone | +1 561-649-5720 |
| Fax | 5616495719 |
Authorized person
| Name | MR. RICHARD HOFFMAN |
| Role | PRESIDENT |
| Phone | 5613121120 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 686684 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARCUS ALAN J | Agent | 20803 BISCAYNE BOULEVARD, AVENTURA, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| HOFFMAN RICHARD | President | 1085 KANE CONCOURSE, BAY HARBOR ISLANDS, FL, 33154 |
| Name | Role | Address |
|---|---|---|
| WITTELS MICHAEL B | Vice President | 1085 KANE CONCOURSE, BAY HARBOR ISLANDS, FL, 33154 |
| Name | Role | Address |
|---|---|---|
| WITTELS MICHAEL B | Secretary | 1085 KANE CONCOURSE, BAY HARBOR ISLANDS, FL, 33154 |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000710132 | TERMINATED | 1000000236261 | DADE | 2011-10-07 | 2021-11-02 | $ 650.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI NORTH SERVICE CENTER, 8175 NW 12TH ST STE 119, MIAMI FL331261828 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
