| Entity Name: | KEITH R. MADONIA, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 29 Oct 2014 (10 years ago) |
| Date of dissolution: | 20 Feb 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 20 Feb 2017 (8 years ago) |
| Document Number: | P14000088572 |
| FEI/EIN Number | 47-2209493 |
| Address: | 2042 SW PROVIDENCE PLACE, PORT ST LUCIE, FL 34953 |
| Mail Address: | 2042 SW PROVIDENCE PLACE, PORT ST LUCIE, FL 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417352485 | 2014-11-03 | 2015-05-01 | 2042 SW PROVIDENCE PL, PORT ST LUCIE, FL, 349534385, US | 2042 SW PROVIDENCE PL, PORT ST LUCIE, FL, 349534385, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 305-310-3702 |
Authorized person
| Name | MR. KEITH RYAN MADONIA |
| Role | OWNER |
| Phone | 3053103702 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT19334 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | IB393A |
| State | FL |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MADONIA, KEITH R | Director | 2042 SW PROVIDENCE PLACE, PORT ST LUCIE, FL 34953 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000109871 | OPTIMUM PHYSICAL THERAPY | EXPIRED | 2014-10-30 | 2019-12-31 | No data | 2042 SW PROVIDENCE PLACE, PORT ST. LUCIE, FL, 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-02-20 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2017-02-20 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-08 |
| Domestic Profit | 2014-10-29 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
