| Entity Name: | REHAB SOURCE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 Sep 1997 (27 years ago) |
| Document Number: | P97000077090 |
| FEI/EIN Number | 65-0778563 |
| Address: | 6825 Davis Blvd, #257, NAPLES, FL 34104 |
| Mail Address: | 6825 Davis Blvd, #257, NAPLES, FL 34104 |
| ZIP code: | 34104 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477574655 | 2006-07-22 | 2022-07-05 | 6825 DAVIS BLVD APT 257, NAPLES, FL, 341045326, US | 6825 DAVIS BLVD, #157, NAPLES, FL, 341045331, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 239-643-7879 |
| Fax | 2396432951 |
Authorized person
| Name | MR. EDSEL PAGKANLUNGAN |
| Role | PRESIDENT |
| Phone | 2396437879 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT0007692 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT0008895 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUECROSS/BLUESHIELD # |
| Number | Y018N |
| State | FL |
| Issuer | BLUECROSS/BLUESHIELD# |
| Number | Y036Q |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PAGKANLUNGAN, EDSEL L. | Agent | 6825 Davis Blvd, #257, NAPLES, FL 34104 |
| Name | Role | Address |
|---|---|---|
| PAGKANLUNGAN, EDSEL | President | 6825 Davis Blvd, #257 NAPLES, FL 34104 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000140969 | COLLIER PHYSICAL THERAPY | ACTIVE | 2016-12-29 | 2026-12-31 | No data | 6825 DAVIS BLVD, APT 257, NAPLES, FL, 34104 |
| G11000047633 | COLLIER PHYSICAL THERAPY | EXPIRED | 2011-05-18 | 2016-12-31 | No data | 3940 RADIO ROAD SUITE 109, NAPLES, FL, 34104 |
| G09000110215 | COLLIER PHYSICAL THERAPY | EXPIRED | 2009-05-23 | 2014-12-31 | No data | 3940 RADIO ROAD, SUITE 109, NAPLES, FL, 34104 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-21 | 6825 Davis Blvd, #257, NAPLES, FL 34104 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-17 | 6825 Davis Blvd, #257, NAPLES, FL 34104 | No data |
| CHANGE OF MAILING ADDRESS | 2021-11-17 | 6825 Davis Blvd, #257, NAPLES, FL 34104 | No data |
| REGISTERED AGENT NAME CHANGED | 1998-04-13 | PAGKANLUNGAN, EDSEL L. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-02-21 |
| ANNUAL REPORT | 2021-05-24 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-05-13 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
