| Entity Name: | UNIVERSITY PHYSICAL MEDICINE, INC, |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Apr 2012 (13 years ago) |
| Document Number: | P12000040339 |
| FEI/EIN Number | 45-5195249 |
| Address: | 1224 OCALA RD., TALLAHASSEE, FL, 32304, US |
| Mail Address: | 1224 OCALA RD., TALLAHASSEE, FL, 32304, US |
| ZIP code: | 32304 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679811970 | 2013-01-21 | 2014-02-04 | 1224 OCALA RD, TALLAHASSEE, FL, 323041548, US | 1224 OCALA RD, TALLAHASSEE, FL, 323041548, US | |||||||||||||||||||||||||||
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| Phone | +1 850-576-2129 |
| Fax | 8505769602 |
Authorized person
| Name | DR. NICHOLAS BELLETTO |
| Role | OWNER/DOCTOR |
| Phone | 8505762129 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME 57039 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | RN 2567282 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BELLETTO NICHOLAS W | Agent | 1224 OCALA RD, TALLAHASSEE, FL, 32304 |
| Name | Role | Address |
|---|---|---|
| BELLETTO NICHOLAS | President | 1224 OCALA RD., TALLAHASSEE, FL, 32304 |
| Name | Role | Address |
|---|---|---|
| BELLETTO NICHOLAS | Secretary | 1224 OCALA RD., TALLAHASSEE, FL, 32304 |
| Name | Role | Address |
|---|---|---|
| BELLETTO NICHOLAS | Treasurer | 1224 OCALA RD., TALLAHASSEE, FL, 32304 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-03-29 |
| ANNUAL REPORT | 2020-02-21 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
