| Entity Name: | PREMIER PEDIATRIC THERAPY P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Jul 2009 (16 years ago) |
| Document Number: | P09000059853 |
| FEI/EIN Number | 800443744 |
| Address: | 1080 East Indiantown Road, JUPITER, FL, 33477, US |
| Mail Address: | 1080 East Indiantown Road, JUPITER, FL, 33477, US |
| ZIP code: | 33477 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114360039 | 2013-04-10 | 2016-01-18 | 1080 E INDIANTOWN RD STE 104, JUPITER, FL, 334775188, US | 1080 E INDIANTOWN RD STE 104, JUPITER, FL, 334775188, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-670-4864 |
| Fax | 5612580812 |
Authorized person
| Name | DR. LAURA MAC |
| Role | SPEECH-LANGUAGE PATHOLOGIST |
| Phone | 5616704864 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA8369 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 890294100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 003349800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MAC LAURA FDr. | Agent | 1080 East Indiantown Road, JUPITER, FL, 33477 |
| Name | Role | Address |
|---|---|---|
| MAC LAURA F | Director | 1080 East Indiantown Road, JUPITER, FL, 33477 |
| Name | Role | Address |
|---|---|---|
| MAC LAURA F | President | 1080 East Indiantown Road, JUPITER, FL, 33477 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-23 | 1080 East Indiantown Road, Suite 203, JUPITER, FL 33477 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-23 | 1080 East Indiantown Road, Suite 203, JUPITER, FL 33477 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-23 | 1080 East Indiantown Road, Suite 203, JUPITER, FL 33477 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-26 | MAC, LAURA F, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-19 |
| ANNUAL REPORT | 2021-01-23 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-02-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
