| Entity Name: | PRODIGY HEALTHCARE SPECIALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Oct 2002 (22 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P02000116008 |
| FEI/EIN Number | 562301065 |
| Address: | 808 3RD AVE WEST, SUITE 204, BRADENTON, FL, 34205 |
| Mail Address: | 808 3RD AVE WEST, SUITE 204, BRADENTON, FL, 34205 |
| ZIP code: | 34205 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497898688 | 2007-02-15 | 2020-08-22 | 2823 US HIGHWAY 301 N, STE. 4, ELLENTON, FL, 342222084, US | 2823 US HIGHWAY 301 N, STE. 4, ELLENTON, FL, 342222084, US | |||||||||||||||||||||||||
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| Phone | +1 941-729-8600 |
| Fax | 9417294440 |
Authorized person
| Name | MRS. RACHEL K RELAO |
| Role | PHYSICAL THERAPIST |
| Phone | 9417298600 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | PT11333 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | Y905G |
| State | FL |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| RELAO RACHEL K | Director | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| RELAO JOSE C | Director | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| Name | Role | Address |
|---|---|---|
| RELAO RACHEL K | President | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| Name | Role | Address |
|---|---|---|
| RELAO RACHEL K | Treasurer | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| Name | Role | Address |
|---|---|---|
| RELAO JOSE C | Vice President | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| Name | Role | Address |
|---|---|---|
| RELAO JOSE C | Secretary | 808 3RD AVE WEST SUITE 204, BRADENTON, FL, 34205 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-27 | 808 3RD AVE WEST, SUITE 204, BRADENTON, FL 34205 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-27 | 808 3RD AVE WEST, SUITE 204, BRADENTON, FL 34205 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-04-25 |
| ANNUAL REPORT | 2007-04-30 |
| ANNUAL REPORT | 2006-04-18 |
| ANNUAL REPORT | 2005-02-22 |
| ANNUAL REPORT | 2004-07-01 |
| ANNUAL REPORT | 2003-04-28 |
| Domestic Profit | 2002-10-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
