| Entity Name: | SULLIVAN REHAB, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Mar 1998 (27 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 04 Jan 2010 (15 years ago) |
| Document Number: | P98000019745 |
| FEI/EIN Number | 650815608 |
| Address: | 537 Laura Road, LAKELAND, FL, 33815, US |
| Mail Address: | 803 CITRUS WOOD LANE, VALRICO, FL, 33594, US |
| ZIP code: | 33815 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881798353 | 2006-09-12 | 2007-08-31 | 116 E BLOOMINGDALE AVE, BRANDON, FL, 335118101, US | 116 E BLOOMINGDALE AVE, BRANDON, FL, 335118101, US | |||||||||||||||||||||||||||
|
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| Phone | +1 813-655-3342 |
| Fax | 8136530894 |
Authorized person
| Name | AMY MARSH |
| Role | DIRECTOR |
| Phone | 8136553342 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTH CARE |
| Number | 6405105 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD PR |
| Number | Y908V |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Marsh Amy L | Agent | 803 Citrus Wood Lane, Valrico, FL, 33594 |
| Name | Role | Address |
|---|---|---|
| SULLIVAN MARVIN R | Chief Executive Officer | 537 Laura Road, Lakeland, FL, 33815 |
| Name | Role | Address |
|---|---|---|
| Marsh Amy | Chief Operating Officer | 537 Laura Road, Lakeland, FL, 33815 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000007826 | SULLIVAN REHAB INC | EXPIRED | 2015-01-22 | 2020-12-31 | No data | 116 E. BLOOMINGDALE AVE., BRANDON, FL, 33511 |
| G15000001070 | SULLIVAN STAFFING FOR PHYSICAL THERAPY | EXPIRED | 2015-01-05 | 2020-12-31 | No data | 116 E. BLOOMINGDALE AVE., BRANDON, FL, 33511 |
| G13000017776 | SULLIVAN REHAB SERVICES | EXPIRED | 2013-02-20 | 2018-12-31 | No data | 116 E. BLOOMINGDALE AVE., BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-23 | 537 Laura Road, LAKELAND, FL 33815 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-09 | 537 Laura Road, LAKELAND, FL 33815 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-29 | Marsh, Amy L | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-29 | 803 Citrus Wood Lane, Valrico, FL 33594 | No data |
| CANCEL ADM DISS/REV | 2010-01-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-02-19 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-03-16 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
