| Entity Name: | REVIVAL PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Jun 1995 (30 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 07 May 2018 (7 years ago) |
| Document Number: | P95000047303 |
| FEI/EIN Number | 59-3325178 |
| Address: | 2301 Park Ave, 201, Orange Park, FL 32073 |
| Mail Address: | 2301 Park Ave, 201, Orange Park, FL 32073 |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841243359 | 2006-05-18 | 2023-07-10 | 2301 PARK AVE STE 1, ORANGE PARK, FL, 320735565, US | 2301 PARK AVE STE 1, ORANGE PARK, FL, 320735565, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 904-264-3005 |
| Fax | 9042640012 |
Authorized person
| Name | MRS. LINZY E. GARCIA |
| Role | CLINICAL DIRECTOR/ OWNER |
| Phone | 9042643005 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 884338400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Garcia, LINZY E | Agent | 4744 SADDLEHORN TRAIL, MIDDLEBURG, FL 32068 |
| Name | Role | Address |
|---|---|---|
| Garcia, Linzy E | President | 2301 Park Ave, 201 Orange Park, FL 32073 |
| Name | Role | Address |
|---|---|---|
| Garcia, Linzy E | Vice President | 2301 Park Ave, 201 Orange Park, FL 32073 |
| Name | Role | Address |
|---|---|---|
| Garcia, Linzy E | Treasurer | 2301 Park Ave, 201 Orange Park, FL 32073 |
| Name | Role | Address |
|---|---|---|
| GARCIA, JEANNETT | Secretary | 2301 Park Ave, 201 Orange Park, FL 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-02 | 2301 Park Ave, 201, Orange Park, FL 32073 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-02 | 2301 Park Ave, 201, Orange Park, FL 32073 | No data |
| AMENDMENT AND NAME CHANGE | 2018-05-07 | REVIVAL PHYSICAL THERAPY, INC. | No data |
| REGISTERED AGENT NAME CHANGED | 2018-01-23 | Garcia, LINZY E | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2002-04-30 | 4744 SADDLEHORN TRAIL, MIDDLEBURG, FL 32068 | No data |
| NAME CHANGE AMENDMENT | 1997-06-12 | HEALTHEX PHYSICAL THERAPY, INC. | No data |
| REINSTATEMENT | 1996-09-24 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-03-05 |
| Amendment and Name Change | 2018-05-07 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-09 |
| Reg. Agent Change | 2016-11-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
