| Entity Name: | KENDALL PROSTHETICS & ORTHOTICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Jan 1995 (30 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 23 Jan 2024 (a year ago) |
| Document Number: | P95000002751 |
| FEI/EIN Number | 65-0543891 |
| Address: | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 |
| Mail Address: | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 |
| ZIP code: | 32934 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578699393 | 2007-02-26 | 2023-03-29 | 3012 LAKE WASHINGTON RD, MELBOURNE, FL, 329347613, US | 3012 LAKE WASHINGTON RD, MELBOURNE, FL, 329347613, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-622-5140 |
| Fax | 6168256139 |
Authorized person
| Name | TODD PAUL ODELL |
| Role | OWNER/OPERATOR |
| Phone | 3216225140 |
Taxonomy
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | POR5 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED HEALTH PLANS |
| Number | 226307 |
| State | FL |
| Issuer | MEDICAID |
| Number | 951163600 |
| State | FL |
| Issuer | U.S. DEPT. OF LABOR OWCP |
| Number | 169843900 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHEILD |
| Number | M2289 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| O'DELL, TODD | Agent | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32394 |
| Name | Role | Address |
|---|---|---|
| O'DELL, TODD | OWNER | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 |
| Name | Role | Address |
|---|---|---|
| O'DELL, TODD | OPERATOR | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G06144900010 | FLORIDA KEYS PROSTHETICS AND ORTHOTICS | ACTIVE | 2006-05-24 | 2026-12-31 | No data | 13044 SW 120 ST, MIAMI, FL, 33186, US |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-01-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-23 | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-23 | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32934 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-23 | O'DELL, TODD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-23 | 3012 LAKE WASHINGTON RD, MELBOURNE, FL 32394 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-01-23 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-02-07 |
| ANNUAL REPORT | 2017-02-24 |
| ANNUAL REPORT | 2016-02-17 |
| ANNUAL REPORT | 2015-03-09 |
| ANNUAL REPORT | 2014-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
