| Entity Name: | LAKE MARY PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LAKE MARY PHYSICAL THERAPY, 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: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 21 Nov 1991 (33 years ago) |
| Date of dissolution: | 28 Sep 2012 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (13 years ago) |
| Document Number: | S95681 |
| FEI/EIN Number |
593093440
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3850 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US |
| Mail Address: | 3850 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316089568 | 2007-02-13 | 2020-08-22 | 820 W LAKE MARY BLVD, SUITE 102, SANFORD, FL, 327735946, US | 820 W LAKE MARY BLVD, SUITE 102, SANFORD, FL, 327735946, US | |||||||||||||||||||||||||
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| Phone | +1 407-321-6644 |
| Fax | 4073217309 |
Authorized person
| Name | MR. GARY JAMES PIACENTINE |
| Role | PRESIDENT |
| Phone | 4073216644 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | PT1410 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | Y922P |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, CHARLES | Director | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| SHAPIRO, ANNA | Director | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| SHAPIRO, ANNA | Secretary | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| SHAPIRO, ANNA | Treasurer | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| PIACENTINE, GARY | Director | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| PIACENTINE, GARY | President | 3850 SHERIDAN ST, HOLLYWOOD, FL |
| SHAPIRO, CHARLES | Agent | 3850 SHERIDAN ST, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | - | - |
| CHANGE OF MAILING ADDRESS | 2011-03-22 | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-19 | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-22 |
| ANNUAL REPORT | 2010-01-19 |
| ANNUAL REPORT | 2009-01-14 |
| ANNUAL REPORT | 2008-01-23 |
| ANNUAL REPORT | 2007-05-02 |
| ANNUAL REPORT | 2006-02-06 |
| ANNUAL REPORT | 2005-03-21 |
| ANNUAL REPORT | 2004-01-12 |
| ANNUAL REPORT | 2003-01-21 |
| ANNUAL REPORT | 2002-04-02 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
