| Entity Name: | SPINE & SPORT INSTITUTE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
SPINE & SPORT INSTITUTE, 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 Nov 1996 (28 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 02 Sep 2022 (3 years ago) |
| Document Number: | P96000090411 |
| FEI/EIN Number |
650704415
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 515 n flagler dr., west palm beach, FL, 33401, US |
| Mail Address: | 515 n flagler dr., west palm beach, FL, 33401, US |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962530659 | 2007-03-02 | 2014-02-28 | 1345 36TH ST, VERO BEACH, FL, 329604848, US | 1345 36TH ST, VERO BEACH, FL, 329604848, US | |||||||||||||||||||||||||
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| Phone | +1 772-567-8040 |
| Fax | 7725678420 |
Authorized person
| Name | MS. MARJORIE R RODD |
| Role | CEO |
| Phone | 7725678040 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT#007940 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER # |
| Number | Y5581 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAPP THOMAS | Chairman | 515 N. Flagler Drive, West Palm Beach, FL, 33401 |
| RAPP THOMAS | CE | 515 N. Flagler Drive, West Palm Beach, FL, 33401 |
| DIPIETRO AMANDA | Officer | 515 n flagler dr., west palm beach, FL, 33401 |
| Tucker Jeffrey | Othe | 515 n flagler dr., west palm beach, FL, 33401 |
| West Dylan | Othe | 515 N Flagler Drive, West Palm Beach, FL, 33401 |
| West Dylan | Agent | 515 N. Flagler Drive, West Palm Beach, FL, 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000117600 | PREMIER PHYSICAL THERAPY AND SPORTS MEDICINE | ACTIVE | 2023-09-22 | 2028-12-31 | - | PO BOX 8600, PORT ST. LUCIE, FL, 34985 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-13 | West, Dylan | - |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-28 | 515 N. Flagler Drive, Ste. 402, West Palm Beach, FL 33401 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-02 | 515 n flagler dr., suite 402, west palm beach, FL 33401 | - |
| AMENDMENT | 2022-09-02 | - | - |
| CHANGE OF MAILING ADDRESS | 2022-09-02 | 515 n flagler dr., suite 402, west palm beach, FL 33401 | - |
| REINSTATEMENT | 2010-09-28 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| AMENDMENT | 2001-04-17 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| AMENDED ANNUAL REPORT | 2023-03-17 |
| ANNUAL REPORT | 2023-02-28 |
| Amendment | 2022-09-02 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2117147200 | 2020-04-15 | 0455 | PPP | 1345 36th st Suite A, VERO BEACH, FL, 32960 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1430718704 | 2021-03-27 | 0455 | PPS | 1355 37th St A, Vero Beach, FL, 32960-7321 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Apr 2025
Sources: Florida Department of State
