| Entity Name: | MAYA PHYSICAL THERAPY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Oct 2002 (22 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 05 Oct 2007 (17 years ago) |
| Document Number: | P02000110860 |
| FEI/EIN Number | 030486608 |
| Address: | 5745 S UNIVERSITY DRIVE, DAVIE, FL, 33328, US |
| Mail Address: | 5745 S UNIVERSITY DRIVE, DAVIE, FL, 33328, US |
| ZIP code: | 33328 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962717868 | 2010-08-16 | 2013-02-08 | 4022 TURQUOISE TRL, WESTON, FL, 333313182, US | 5745 S UNIVERSITY DR, DAVIE, FL, 333286114, US | |||||||||||||||||||||||||
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| Phone | +1 954-252-9619 |
| Fax | 9542529620 |
Authorized person
| Name | SANJAIMON K NADUPARAMBIL |
| Role | PRESIDENT |
| Phone | 9542740415 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT19750 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004243200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NADUPARAMPIL SANJAIMON | Agent | 4022 TURQUOISE TRAIL, WESTON, FL, 33331 |
| Name | Role | Address |
|---|---|---|
| NADUPARAMPIL SANJAIMON | President | 4022 TURQUOISE TRAIL, WESTON, FL, 33331 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000033528 | MAYA PHYSICAL THERAPY INC. | ACTIVE | 2021-03-10 | 2026-12-31 | No data | 110 N FEDERAL HIGHWAY UNIT 203, HALLANDALE, FL, 33009 |
| G11000109646 | PHYSICAL THERAPY AND WELLNES CENTER | EXPIRED | 2011-11-10 | 2016-12-31 | No data | 5745 S UNIVERSITY DRIVE, DAVIE, FL, 33328 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-30 | 5745 S UNIVERSITY DRIVE, DAVIE, FL 33328 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-30 | 5745 S UNIVERSITY DRIVE, DAVIE, FL 33328 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-07-08 | 4022 TURQUOISE TRAIL, WESTON, FL 33331 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-07-08 | NADUPARAMPIL, SANJAIMON | No data |
| CANCEL ADM DISS/REV | 2007-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CANCEL ADM DISS/REV | 2003-10-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-07 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-02 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
