| Entity Name: | CHIPLEY PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Oct 2002 (22 years ago) |
| Document Number: | P02000108176 |
| FEI/EIN Number | 820566563 |
| Address: | 1567 Main St, CHIPLEY, FL, 32428, US |
| Mail Address: | 1567 Main St, CHIPLEY, FL, 32428, US |
| ZIP code: | 32428 |
| County: | Washington |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073857298 | 2012-11-15 | 2012-11-15 | 1414 MAIN ST STE 3A, CHIPLEY, FL, 324286951, US | 625 W BALDWIN RD STE C, PANAMA CITY, FL, 324053359, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-638-3387 |
| Fax | 8504151967 |
Authorized person
| Name | RUBEN ALONZO LAUREL |
| Role | CEO |
| Phone | 8506383387 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT13658 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT27435 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT23655 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT14591 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT26409 |
| State | FL |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHIPLEY PHYSICAL THERAPY INC 401(K) PLAN | 2023 | 820566563 | 2024-09-04 | CHIPLEY PHYSICAL THERAPY INC | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-04 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-02-01 |
| Business code | 621340 |
| Sponsor’s telephone number | 8506383387 |
| Plan sponsor’s address | 1567 MAIN STREET, CHIPLEY, FL, 32428 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-13 |
| Name of individual signing | NICK RICE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| LAUREL RUBEN A | Agent | 1567 Main St, CHIPLEY, FL, 32428 |
| Name | Role | Address |
|---|---|---|
| LAUREL RUBEN A | Chief Executive Officer | 1567 Main St, CHIPLEY, FL, 32428 |
| Name | Role | Address |
|---|---|---|
| Laurel Lorrie A | Vice President | 1567 Main St, CHIPLEY, FL, 32428 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000004105 | MARIANNA PHYISCAL THERAPY | EXPIRED | 2010-01-13 | 2015-12-31 | No data | 1414 MAIN ST SUITE 3A, CHIPLEY, FL, 32428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-08 | 1567 Main St, CHIPLEY, FL 32428 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-08 | 1567 Main St, CHIPLEY, FL 32428 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-08 | 1567 Main St, CHIPLEY, FL 32428 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-01-31 | LAUREL, RUBEN ACEO | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001164574 | LAPSED | 13000069CA | JACKSON COUNTY FL COUNTY CT | 2013-05-08 | 2018-07-02 | $12,349.48 | YALE MARIANNA, LLC, 10 NEW KING STREET, SUITE 102, WHITE PLAINS, NY 10604 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
