| Entity Name: | INTEGRATIVE REHAB MEDICINE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Jan 2019 (6 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Aug 2021 (4 years ago) |
| Document Number: | P19000008685 |
| FEI/EIN Number | 83-3996655 |
| Address: | 9351 Corkscrew Road, ESTERO, FL, 33928, US |
| Mail Address: | 9351 Corkscrew Road, FORT MYERS, FL, 33908, US |
| ZIP code: | 33928 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821658428 | 2019-06-17 | 2023-08-28 | 9250 CORKSCREW RD STE 15, ESTERO, FL, 339283217, US | 9351 CORKSCREW RD # 103, ESTERO, FL, 339286801, US | |||||||||||||||||||
|
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| Phone | +1 239-687-3199 |
Authorized person
| Name | SEBASTIAN KLISIEWICZ |
| Role | OWNER |
| Phone | 7738950708 |
Taxonomy
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DO |
| Number | OS12803 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| lewis brian kcpa | Agent | 2139 SE 5TH AVE, CAPE CORAL, FL, 33990 |
| Name | Role | Address |
|---|---|---|
| KLISIEWICZ SEBASTIAN | President | 21175 PALESE DRIVE, ESTERO, FL, 33928 |
| Name | Role | Address |
|---|---|---|
| KLISIEWICZ EUNIKA | Vice President | 21175 PALESE DRIVE, ESTERO, FL, 33928 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-14 | 9351 Corkscrew Road, Ste 103, ESTERO, FL 33928 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-14 | 9351 Corkscrew Road, Ste 103, ESTERO, FL 33928 | No data |
| AMENDMENT | 2021-08-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-08-04 | lewis, brian k, cpa | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-08-04 | 2139 SE 5TH AVE, CAPE CORAL, FL 33990 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-14 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-28 |
| Amendment | 2021-08-04 |
| ANNUAL REPORT | 2021-08-02 |
| ANNUAL REPORT | 2020-04-02 |
| Domestic Profit | 2019-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
