| Entity Name: | PHYSIO SPORTS MED, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Apr 2012 (13 years ago) |
| Document Number: | P12000039496 |
| FEI/EIN Number | 45-5213672 |
| Address: | 2102 Country Side Drive, Apopka, FL, 32712, US |
| Mail Address: | 2102 Country Side Drive, Apopka, FL, 32712, US |
| ZIP code: | 32712 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871853929 | 2012-05-23 | 2012-05-23 | 1783 IMPERIAL PALM DR, APOPKA, FL, 327122476, US | 1783 IMPERIAL PALM DR, APOPKA, FL, 327122476, US | |||||||||||||||||
|
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| Phone | +1 908-723-0876 |
Authorized person
| Name | FRANK B VAN KOUWEN |
| Role | PRESIDENT |
| Phone | 9087230876 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | 27064 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VAN KOUWEN FRANK B | Agent | 2102 Country Side Drive, Apopka, FL, 32712 |
| Name | Role | Address |
|---|---|---|
| VAN KOUWEN FRANK B | Director | 2102 Country Side Drive, Apopka, FL, 32712 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-23 | 2102 Country Side Drive, Apopka, FL 32712 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-23 | 2102 Country Side Drive, Apopka, FL 32712 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-23 | 2102 Country Side Drive, Apopka, FL 32712 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-07 |
| ANNUAL REPORT | 2023-03-18 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-06-14 |
| ANNUAL REPORT | 2019-05-12 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-03-08 |
| ANNUAL REPORT | 2016-03-23 |
| ANNUAL REPORT | 2015-01-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
