| Entity Name: | FLORIDA PHYSICAL THERAPY SPECIALISTS PORT CHARLOTTE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Dec 2004 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Apr 2022 (3 years ago) |
| Document Number: | P04000172932 |
| FEI/EIN Number | 202103340 |
| Address: | 24420 SANDHILL BLVD SUITE 301, PUNTA GORDA, FL, 33983 |
| Mail Address: | PO BOX 1551, VENICE, FL, 34284-1551 |
| ZIP code: | 33983 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548262488 | 2005-08-11 | 2018-04-16 | PO BOX 1551, VENICE, FL, 342841551, US | 24430 SANDHILL BLVD UNIT 301, PUNTA GORDA, FL, 339835216, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 941-468-1660 |
| Fax | 9414846024 |
| Phone | +1 941-625-2907 |
| Fax | 9417661631 |
Authorized person
| Name | MR. SERGIO E VALDIVIA |
| Role | PRESIDENT |
| Phone | 9414681660 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT10727 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | Y053N |
| State | FL |
| Issuer | HIGHMARK BCBS |
| Number | 001872584 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA SERGIO | Agent | 24420 SANDHILL BLVD SUITE 301, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA SERGIO | President | 24901 SANDHILL BLVD SUITE 1, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA SERGIO | Secretary | 24901 SANDHILL BLVD SUITE 1, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA SERGIO | Treasurer | 24901 SANDHILL BLVD SUITE 1, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA SERGIO | Director | 24901 SANDHILL BLVD SUITE 1, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| VALDIVIA FERNADA | Vice President | P.O. BOX 1551, VENICE, FL, 342841551 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000100077 | FLORIDA PHYSICAL THERAPY SPECIALISTS PORT CHARLOTTE | EXPIRED | 2016-09-12 | 2021-12-31 | No data | 24420 SANDHILL BLVD. SUITE 301, PUNTA GORDA, FL, 33983 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-04-13 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-13 | VALDIVIA, SERGIO | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2016-12-05 | FLORIDA PHYSICAL THERAPY SPECIALISTS PORT CHARLOTTE INC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-17 | 24420 SANDHILL BLVD SUITE 301, PUNTA GORDA, FL 33983 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-17 | 24420 SANDHILL BLVD SUITE 301, PUNTA GORDA, FL 33983 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-22 |
| REINSTATEMENT | 2022-04-13 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-01-10 |
| Amendment and Name Change | 2016-12-05 |
| ANNUAL REPORT | 2016-02-29 |
| ANNUAL REPORT | 2015-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
