| Name: | FORM & FUNCTION PHYSICAL THERAPY AND SPORTS MEDICINE, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Dec 2013 (11 years ago) |
| Identification Number: | 000869919 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 250 SCRABBLETOWN ROAD, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | PROVIDES PHYSICAL THERAPY SERVICES |
| NAICS: | 621340 - Offices of Physical, Occupational and Speech Therapists, and Audiologists |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629486550 | 2014-07-23 | 2018-01-31 | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 028523016, US | 250 SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 028523016, US | |||||||||||||||||
|
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| Phone | +1 617-326-3008 |
Authorized person
| Name | GUERRINO BONI |
| Role | OWNER |
| Phone | 4014658244 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | PT01838 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GUERRINO BONI | Agent | 22 INKBERRY TRAIL, NARRAGANSETT, RI, 02882, USA |
| Number | Name | File Date |
|---|---|---|
| 202445155770 | Annual Report | 2024-02-01 |
| 202343215530 | Annual Report | 2023-12-04 |
| 202343203500 | Statement of Change of Registered/Resident Agent | 2023-12-04 |
| 202215903930 | Annual Report | 2022-04-27 |
| 202105473950 | Annual Report | 2021-11-29 |
| 202077886190 | Annual Report | 2020-11-30 |
| 201927818820 | Annual Report | 2019-11-21 |
| 201881980300 | Annual Report | 2018-11-30 |
| 201754277830 | Annual Report | 2017-11-30 |
| 201628235340 | Annual Report | 2016-11-29 |
Date of last update: 18 Oct 2024
Sources: Rhode Island Department of State
