| Entity Name: | STARACE TOTAL BALANCE PHYSICAL THERAPY P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Feb 2017 (8 years ago) |
| Document Number: | P17000018562 |
| FEI/EIN Number | 82-0640272 |
| Address: | 2550 US HIGHWAY 1, BUNNELL, FL, 32110, US |
| Mail Address: | 2550 US HIGHWAY 1, BUNNELL, FL, 32110, US |
| ZIP code: | 32110 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043750276 | 2017-03-07 | 2024-06-06 | 32 BANNBURY LN, PALM COAST, FL, 321378848, US | 2550 N STATE ST UNIT 4, BUNNELL, FL, 321103418, US | |||||||||||||||||||||||||||
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| Phone | +1 732-668-4988 |
| Phone | +1 386-385-8749 |
| Fax | 3866931798 |
Authorized person
| Name | DR. MICHAEL BRANDON STARACE |
| Role | DOCTOROFPHYSICALTHERAPY/PRESIDENT |
| Phone | 7326684988 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT28234 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1689006744 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STARACE MICHAEL BDR. | Agent | 32 BANNBURY LANE, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| STARACE MICHAEL BDR. | President | 32 BANNBURY LANE, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Starace Omayra R | Vice President | 32 Bannbury Lane, Palm Coast, FL, 32137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-06-30 | 2550 US HIGHWAY 1, SUITE 4, BUNNELL, FL 32110 | No data |
| CHANGE OF MAILING ADDRESS | 2017-06-30 | 2550 US HIGHWAY 1, SUITE 4, BUNNELL, FL 32110 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-26 |
| Domestic Profit | 2017-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
