| Entity Name: | CENTER FOR ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Dec 1990 (34 years ago) |
| Document Number: | S21526 |
| FEI/EIN Number | 593044545 |
| Address: | 2615 CENTENNIAL BLVD., SUITE 101, TALLAHASSEE, FL, 32308 |
| Mail Address: | 2615 CENTENNIAL BLVD., SUITE 101, TALLAHASSEE, FL, 32308 |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114001377 | 2006-10-24 | 2016-03-17 | 2615 CENTENNIAL BLVD, SUITE 101, TALLAHASSEE, FL, 323080586, US | 2615 CENTENNIAL BLVD, SUITE 101, TALLAHASSEE, FL, 323080586, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 850-656-1837 |
| Fax | 8508172917 |
| Fax | 8508772917 |
Authorized person
| Name | MS. KAITLIN R SCARBARY |
| Role | ADMINISTRATOR |
| Phone | 8506561837 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT2671 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT11534 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Gray Richard W | Agent | 2615 CENTENNIAL BLVD. #101, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| Miller J. M | President | 2615 CENTENNIAL BLVD. #101, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| GRAY RICHARD W | Chief Executive Officer | 2615 CENTENNIAL BLVD. #101, TALLAHASSEE, FL, 32308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2008-02-18 | No data | No data |
| CANCEL ADM DISS/REV | 2007-09-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
