| Entity Name: | PALM BEACH AQUATICS & PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Nov 2002 (22 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 30 Oct 2017 (7 years ago) |
| Document Number: | P02000120082 |
| FEI/EIN Number | 600004120 |
| Address: | 3111 W Boynton Beach Blvd, BOYNTON BEACH, FL, 33436, US |
| Mail Address: | 3111 W BOYNTON BEACH BLVD, BOYNTON BEACH, FL, 33436, US |
| ZIP code: | 33436 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841263464 | 2006-02-13 | 2014-08-28 | 5130 LINTON BLVD, SUITE H-1, DELRAY BEACH, FL, 334846596, US | 3111 W BOYNTON BEACH BLVD, SUITE 200, BOYNTON BEACH, FL, 334364613, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-865-2800 |
| Fax | 5618650097 |
| Phone | +1 561-742-3283 |
| Fax | 5617423280 |
Authorized person
| Name | MRS. ADRI HERNANDEZ MOTE |
| Role | PRESIDENT |
| Phone | 5618652800 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DB1527 |
| State | FL |
| Issuer | BCBS GROUP NUMBER |
| Number | Y912H |
| State | FL |
| Issuer | BCBS |
| Number | Y90RQ |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOTE DAVID | Agent | 10531 ST. ANDREWS ROAD, BOYNTON BEACH, FL, 33436 |
| Name | Role | Address |
|---|---|---|
| MOTE DAVID | President | 10531 ST. ANDREWS ROAD, BOYNTON BEACH, FL, 33436 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-06 | 3111 W Boynton Beach Blvd, Suite 100, BOYNTON BEACH, FL 33436 | No data |
| AMENDMENT | 2017-10-30 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-10-30 | MOTE, DAVID | No data |
| CHANGE OF MAILING ADDRESS | 2014-10-02 | 3111 W Boynton Beach Blvd, Suite 100, BOYNTON BEACH, FL 33436 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-02-19 |
| Amendment | 2017-10-30 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-01-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
