| Entity Name: | FUNCTIONAL INTERVENTIONS THERAPY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Jul 2021 (4 years ago) |
| Document Number: | P21000067871 |
| FEI/EIN Number | 87-1867772 |
| Address: | 1850 Rye Rd, Bradenton, FL, 34212, US |
| Mail Address: | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238, US |
| ZIP code: | 34212 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184397986 | 2021-07-28 | 2024-02-07 | 5775 NANNYBERRY CIR, SARASOTA, FL, 342385169, US | 1850 RYE RD, BRADENTON, FL, 342129038, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 941-777-0527 |
| Fax | 9413158546 |
Authorized person
| Name | LESLEY SAMULAK |
| Role | OCCUPATIONAL THERAPIST |
| Phone | 9417770527 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SAMULAK LESLEY | Agent | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| Name | Role | Address |
|---|---|---|
| SAMULAK LESLEY | President | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| Name | Role | Address |
|---|---|---|
| SAMULAK LESLEY | Vice President | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| Name | Role | Address |
|---|---|---|
| SAMULAK LESLEY | Secretary | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000014273 | FIT PELVIC HEALTH | ACTIVE | 2023-01-30 | 2028-12-31 | No data | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| G22000048192 | FIT PELVIC HEALTH SARASOTA | ACTIVE | 2022-04-15 | 2027-12-31 | No data | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| G21000099385 | C-SECTION THERAPIST | ACTIVE | 2021-07-30 | 2026-12-31 | No data | 5775 NANNYBERRY CIR, SARASOTA, FL, 34238 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-09 | 1850 Rye Rd, Bradenton, FL 34212 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-03-21 |
| Domestic Profit | 2021-07-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
