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  5. PHYSIO-MED INC.

PHYSIO-MED INC.

Company Details

Entity Name: PHYSIO-MED INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 30 Aug 1995 (29 years ago)
Last Event: AMENDMENT
Event Date Filed: 29 Aug 2017 (7 years ago)
Document Number: P95000067521
FEI/EIN Number 59-3333949
Address: 2765 S. Bay Street, Eustis, FL 32726
Mail Address: 2765 S. Bay Street, Eustis, FL 32726
ZIP code: 32726
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720096720 2006-08-04 2022-02-02 2765 S BAY ST, EUSTIS, FL, 327266501, US 2765 S BAY ST, EUSTIS, FL, 327266501, US

Contacts
Phone +1 352-589-5595
Fax 3525895747
Phone +1 352-589-5955

Authorized person
Name SCOTTIE BULL
Role PRESIDENT
Phone 3525895595

Taxonomy
Taxonomy Code 261QR0400X - Rehabilitation Clinic/Center
Is Primary Yes

Other Provider Identifiers
Issuer AETNA
Number 72890070
Issuer BCBS
Number Q3N
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2023 593333949 2024-09-10 PHYSIO-MED INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2024-09-10
Name of individual signing SCOTTIE BULL
Valid signature Filed with authorized/valid electronic signature
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2023 593333949 2024-11-18 PHYSIO-MED INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2024-11-18
Name of individual signing SCOTTIE BULL
Valid signature Filed with authorized/valid electronic signature
PHYSIO MED, INC. 401K PROFIT SHARING PLAN AND TRUST 2023 593333949 2024-05-10 PHYSIO MED INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2024-05-10
Name of individual signing SCOTTIE BULL
Valid signature Filed with authorized/valid electronic signature
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2022 593333949 2023-10-03 PHYSIO-MED INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY ST, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2023-10-03
Name of individual signing TODD HELTON
Valid signature Filed with authorized/valid electronic signature
PHYSIO MED INC 401K PROFIT SHARING PLAN AND TRUST 2022 593333949 2023-05-03 PHYSIO MED INC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2023-05-03
Name of individual signing SCOTTIE BULL
Valid signature Filed with authorized/valid electronic signature
PHYSIO MED INC 401K PROFIT SHARING PLAN AND TRUST 2021 593333949 2022-09-09 PHYSIO MED INC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2021 593333949 2022-09-09 PHYSIO-MED INC. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 2765 S. BAY STREET, EUSTIS, FL, 32726
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2020 593333949 2021-07-26 PHYSIO-MED INC. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 443 PLAZA DRIVE, EUSTIS, FL, 32726
PHYSIO MED INC 401K PROFIT SHARING PLAN AND TRUST 2020 593333949 2021-06-25 PHYSIO MED INC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s address 443 PLAZA DRIVE, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2021-06-25
Name of individual signing CECIL ROBERTS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-25
Name of individual signing CECIL ROBERTS
Valid signature Filed with authorized/valid electronic signature
PHYSIO-MED INC. CASH BALANCE PENSION PLAN 2019 593333949 2020-09-01 PHYSIO-MED INC. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621340
Sponsor’s telephone number 3525895595
Plan sponsor’s DBA name 17ROMANS524
Plan sponsor’s address 443 PLAZA DRIVE, EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2020-09-01
Name of individual signing CECIL ROBERTS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Bull, Scottie Agent 2765 S. Bay Street, Eustis, FL 32726

Director

Name Role
ELITE REHAB MANAGEMENT LLC Director

President

Name Role Address
Bull, Scottie President 2765 S. Bay Street, Eustis, FL 32726

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-01-12 2765 S. Bay Street, Eustis, FL 32726 No data
CHANGE OF MAILING ADDRESS 2022-01-12 2765 S. Bay Street, Eustis, FL 32726 No data
REGISTERED AGENT ADDRESS CHANGED 2022-01-12 2765 S. Bay Street, Eustis, FL 32726 No data
REGISTERED AGENT NAME CHANGED 2017-08-31 Bull, Scottie No data
AMENDMENT 2017-08-29 No data No data
AMENDMENT 2015-11-12 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-08
ANNUAL REPORT 2023-04-21
ANNUAL REPORT 2022-01-12
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-05-12
AMENDED ANNUAL REPORT 2019-08-05
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-03-12
AMENDED ANNUAL REPORT 2017-09-25
AMENDED ANNUAL REPORT 2017-08-31

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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