| Entity Name: | CRESTVIEW PHYSICAL THERAPY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
CRESTVIEW PHYSICAL THERAPY INC is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 04 Jan 1995 (30 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 09 Jul 2012 (13 years ago) |
| Document Number: | P95000001360 |
| FEI/EIN Number |
593291910
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 577 BROOKMEADE DR, CRESTVIEW, FL, 32539, US |
| Mail Address: | P O BOX 2010, CRESTVIEW, FL, 32536, US |
| ZIP code: | 32539 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1295784668 | 2006-05-10 | 2022-11-22 | PO BOX 2010, CRESTVIEW, FL, 325368010, US | 577 BROOKMEADE DR, CRESTVIEW, FL, 325396029, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-682-7466 |
| Fax | 8506826591 |
Authorized person
| Name | THOMAS A. MILLER |
| Role | PRESIDENT |
| Phone | 8506827466 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT0002988 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT2988 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA18906 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 887782301 |
| State | FL |
| Issuer | BCBS GRP NUMBER |
| Number | Y902Q |
| State | FL |
| Issuer | TRICARE - INDIVIDUAL NUMB |
| Number | 422880208 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 650024403 |
| State | FL |
| Issuer | PHYSICAL THERAPIST ASSIST |
| Number | PTA18906 |
| State | FL |
| Issuer | MEDICAID |
| Number | 887782300 |
| State | FL |
| Issuer | COMMERCIAL INS NUMBERS |
| Number | PT0002988 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MILLER THOMAS A | President | 105 woodland Dr., CRESTVIEW, FL, 32539 |
| MILLER THOMAS A | Vice President | 105 woodland Dr., CRESTVIEW, FL, 32539 |
| MILLER THOMAS A | Secretary | 105 woodland Dr., CRESTVIEW, FL, 32539 |
| MILLER THOMAS A | Treasurer | 105 woodland Dr., CRESTVIEW, FL, 32539 |
| MILLER THOMAS A | Director | 105 Woodland Dr, CRESTVIEW, FL, 32539 |
| MILLER THOMAS A | Agent | 577 BROOKMEADE DRIVE, CRESTVIEW, FL, 32539 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000182374 | CRESTVIEW PHYSICAL THERAPY CLINIC | ACTIVE | 2009-12-08 | 2029-12-31 | - | PO BOX 2010, CRESTVIEW, FL, 32536 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2012-07-09 | CRESTVIEW PHYSICAL THERAPY INC | - |
| REGISTERED AGENT NAME CHANGED | 2009-04-16 | MILLER, THOMAS APT | - |
| REINSTATEMENT | 2005-10-07 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | - | - |
| CHANGE OF MAILING ADDRESS | 2001-02-08 | 577 BROOKMEADE DR, CRESTVIEW, FL 32539 | - |
| REGISTERED AGENT ADDRESS CHANGED | 1999-04-27 | 577 BROOKMEADE DRIVE, CRESTVIEW, FL 32539 | - |
| CHANGE OF PRINCIPAL ADDRESS | 1997-04-14 | 577 BROOKMEADE DR, CRESTVIEW, FL 32539 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-06-03 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-05-28 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-24 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8140607409 | 2020-05-18 | 0491 | PPP | 577 BROOKMEADE DR, CRESTVIEW, FL, 32539-6029 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 May 2025
Sources: Florida Department of State
