| Entity Name: | PBISM WEST BOCA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Apr 2019 (6 years ago) |
| Document Number: | P19000037765 |
| FEI/EIN Number | 83-4682437 |
| Address: | 21737 FL-7, BOCA RATON, FL, 33428, US |
| Mail Address: | 3848 FAU BLVD, STE 105, BOCA RATON, FL, 33431, US |
| ZIP code: | 33428 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053978353 | 2019-05-22 | 2019-05-22 | 3848 FAU BLVD STE 105, BOCA RATON, FL, 334316437, US | 21737 STATE ROAD 7, BOCA RATON, FL, 334282822, US | |||||||||||||||||
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| Phone | +1 561-395-2920 |
| Phone | +1 561-997-5210 |
| Fax | 5613312542 |
Authorized person
| Name | BRAD VAN PELT |
| Role | PRESIDENT |
| Phone | 5613952920 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VAN PELT BRAD | Agent | 3848 FAU BLVD, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| VAN PELT DANA | Chief Executive Officer | 3848 FAU BLVD SUITE 105, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| VAN PELT BRAD | President | 3848 FAU BLVD SUITE 105, BOCA RATON, FL, 33431 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000058641 | PALM BEACH INSTITUTE OF SPORTS MEDICINE | ACTIVE | 2019-05-16 | 2029-12-31 | No data | 3848 FAU BLVD, STE 105, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-07-01 | 21737 FL-7, BOCA RATON, FL 33428 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-01 | 21737 FL-7, BOCA RATON, FL 33428 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-20 |
| Domestic Profit | 2019-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
