| Entity Name: | MODERN THERAPY WORKS INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jun 1997 (28 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 16 May 2023 (2 years ago) |
| Document Number: | P97000049634 |
| FEI/EIN Number | 593447874 |
| Address: | 7036 MARINER BLVD., SPRING HILL, FL, 34609 |
| Mail Address: | 7036 MARINER BLVD., SPRING HILL, FL, 34609 |
| ZIP code: | 34609 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1659318889 | 2006-05-31 | 2024-06-24 | 7036 MARINER BLVD, SPRING HILL, FL, 346091000, US | 7036 MARINER BLVD, SPRING HILL, FL, 346091000, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-597-1530 |
| Fax | 3525970502 |
Authorized person
| Name | MR. PREM J KUMAR |
| Role | ADMINSTRATOR |
| Phone | 3525971530 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT19290 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2251C2600X - Cardiopulmonary Physical Therapist |
| License Number | PT19290 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2251G0304X - Geriatric Physical Therapist |
| License Number | PT19290 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| License Number | PTA18578 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225700000X - Massage Therapist |
| License Number | MA41964 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT2608 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225XE1200X - Ergonomics Occupational Therapist |
| License Number | OT2608 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225XH1200X - Hand Occupational Therapist |
| License Number | OT2608 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225XN1300X - Neurorehabilitation Occupational Therapist |
| License Number | OT6562 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225XP0200X - Pediatric Occupational Therapist |
| License Number | OT6562 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2278P1005X - Pulmonary Rehabilitation Certified Respiratory Therapist |
| License Number | TT7874 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA3173 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUECROSS BLUESHIELD # |
| Number | Q4J |
| State | FL |
| Issuer | MEDICAID |
| Number | 884395300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JAYANANTHEM PREMKUMAR | Agent | 7036 MARINER BLVD., SPRING HILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| MOONGA RUTH | Vice President | 7036 MARINER BLVD, SPRING HILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| PREM JAYANANTHAM KUMAR | President | 12404 CENTENNIAL STREET, SPRINGHILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| PREM JAYANANTHAM KUMAR | Secretary | 12404 CENTENNIAL STREET, SPRINGHILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| PREM JAYANANTHAM KUMAR | Treasurer | 12404 CENTENNIAL STREET, SPRINGHILL, FL, 34609 |
| Name | Role | Address |
|---|---|---|
| PREM JAYANANTHAM KUMAR | Director | 12404 CENTENNIAL STREET, SPRINGHILL, FL, 34609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2023-05-16 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-23 | 7036 MARINER BLVD., SPRING HILL, FL 34609 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-25 | JAYANANTHEM, PREMKUMAR | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-04-10 | 7036 MARINER BLVD., SPRING HILL, FL 34609 | No data |
| CHANGE OF MAILING ADDRESS | 2003-04-10 | 7036 MARINER BLVD., SPRING HILL, FL 34609 | No data |
| REINSTATEMENT | 2000-02-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| Amendment | 2023-05-16 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-05-06 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
