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  5. GULF COAST PHYSICAL MEDICINE, INC.

GULF COAST PHYSICAL MEDICINE, INC.

Company Details

Entity Name: GULF COAST PHYSICAL MEDICINE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 01 Nov 2007 (17 years ago)
Date of dissolution: 23 Sep 2011 (13 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2011 (13 years ago)
Document Number: P07000119575
FEI/EIN Number 261360964
Address: 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781
Mail Address: 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781
ZIP code: 33781
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1902081649 2007-12-31 2007-12-31 6250 PARK BLVD, PINELLAS PARK, FL, 337813237, US 6250 PARK BLVD, PINELLAS PARK, FL, 337813237, US

Contacts
Phone +1 727-541-2520
Fax 7275448971

Authorized person
Name DR. KEVIN R LEE
Role PRESIDENT
Phone 7275412520

Taxonomy
Taxonomy Code 111N00000X - Chiropractor
License Number CH7203
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 381417300
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GULF COAST PHYSICAL MEDICINE, INC. 401K PLAN AND TRUST 2012 261360964 2013-07-23 GULF COAST PHYSICAL MEDICINE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 7275412520
Plan sponsor’s address 6250 PARK BLVD, PINELLAS, FL, 33781

Signature of
Role Plan administrator
Date 2013-07-23
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-23
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
GULF COAST PHYSICAL MEDICINE, INC. 401K PLAN AND TRUST 2011 261360964 2012-04-17 GULF COAST PHYSICAL MEDICINE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 7275412520
Plan sponsor’s address 6250 PARK BLVD, PINELLAS, FL, 33781

Plan administrator’s name and address
Administrator’s EIN 261360964
Plan administrator’s name GULF COAST PHYSICAL MEDICINE, INC.
Plan administrator’s address 6250 PARK BLVD, PINELLAS, FL, 33781
Administrator’s telephone number 7275412520

Signature of
Role Plan administrator
Date 2012-04-17
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
GULF COAST PHYSICAL MEDICINE, INC. 401K PLAN AND TRUST 2010 261360964 2011-06-30 GULF COAST PHYSICAL MEDICINE, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 7275412520
Plan sponsor’s address 6250 PARK BLVD, PINELLAS, FL, 33781

Plan administrator’s name and address
Administrator’s EIN 261360964
Plan administrator’s name GULF COAST PHYSICAL MEDICINE, INC.
Plan administrator’s address 6250 PARK BLVD, PINELLAS, FL, 33781
Administrator’s telephone number 7275412520

Signature of
Role Plan administrator
Date 2011-06-30
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-30
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
GULF COAST PHYSICAL MEDICINE, INC. 401K PLAN AND TRUST 2010 261360964 2011-06-30 GULF COAST PHYSICAL MEDICINE, INC. 4
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 7275412520
Plan sponsor’s address 6250 PARK BLVD, PINELLAS, FL, 33781

Plan administrator’s name and address
Administrator’s EIN 261360964
Plan administrator’s name GULF COAST PHYSICAL MEDICINE, INC.
Plan administrator’s address 6250 PARK BLVD, PINELLAS, FL, 33781
Administrator’s telephone number 7275412520
GULF COAST PHYSICAL MEDICINE, INC. 401K PLAN AND TRUST 2009 261360964 2010-10-11 GULF COAST PHYSICAL MEDICINE, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 7275412520
Plan sponsor’s address 6250 PARK BLVD, PINELLAS, FL, 33781

Plan administrator’s name and address
Administrator’s EIN 261360964
Plan administrator’s name GULF COAST PHYSICAL MEDICINE, INC.
Plan administrator’s address 6250 PARK BLVD, PINELLAS, FL, 33781
Administrator’s telephone number 7275412520

Signature of
Role Plan administrator
Date 2010-10-11
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-11
Name of individual signing KEVIN LEE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LEE KEVIN R Agent 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

President

Name Role Address
LEE KEVIN R President 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

Treasurer

Name Role Address
LEE KEVIN R Treasurer 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

Director

Name Role Address
LEE KEVIN R Director 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781
LYNK GARY Director 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

Vice President

Name Role Address
LYNK GARY Vice President 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

Secretary

Name Role Address
LYNK GARY Secretary 6250 PARK BOULEVARD, PINELLAS PARK, FL, 33781

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2011-09-23 No data No data

Documents

Name Date
ANNUAL REPORT 2010-04-28
ANNUAL REPORT 2009-04-29
ANNUAL REPORT 2008-06-27
Domestic Profit 2007-11-01

Related by officers

LEE KEVIN R

KL THERAPY, INC. KACEY'S COMPANIONS, INC. GULF COAST REHABILITATION AND WELLNESS CENTER, INC. KEVIN R. LEE FAMILY CHIROPRACTIC CENTER, P.A.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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