| Entity Name: | 123 THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Sep 2011 (13 years ago) |
| Document Number: | P11000084472 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 14040 NW 7th ave, Miami, FL, 33168, US |
| Mail Address: | 14040 NW 7th ave, Miami, FL, 33168, US |
| ZIP code: | 33168 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538592977 | 2013-08-20 | 2022-11-30 | 3670 N 54TH AVE, HOLLYWOOD, FL, 330212340, US | 3670 N 54TH AVE, HOLLYWOOD, FL, 330212340, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Fax | 7542011390 |
| Phone | +1 305-651-9311 |
Authorized person
| Name | MARIANA TALARICO DE NOLASCO |
| Role | PRESIDENT/OWNER |
| Phone | 3056519311 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT21718 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA20109 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA19414 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA21752 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA22491 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA10823 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA11876 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004221900 |
| State | FL |
| Name | Role |
|---|---|
| EDWARD GARCIA, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| TALARICO DE NOLASCO MARIANA B | Director | 14040 NW 7th ave, Miami, FL, 33168 |
| Name | Role | Address |
|---|---|---|
| TALARICO DE NOLASCO MARIANA B | President | 14040 NW 7th ave, Miami, FL, 33168 |
| Name | Role | Address |
|---|---|---|
| NOLASCO MARTIN | Vice President | 14040 NW 7th ave, Miami, FL, 33168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-12-01 | 14040 NW 7th ave, Miami, FL 33168 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-12-01 | EDWARD GARCIA, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-12-01 | 6163 MIAMI LAKES DR. E, MIAMI LAKES, FL 33014 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-28 | 14040 NW 7th ave, Miami, FL 33168 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| AMENDED ANNUAL REPORT | 2023-12-01 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-03-23 |
| ANNUAL REPORT | 2016-04-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
