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STARGAIT MEDFORD PHYSICAL THERAPY, LLC

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Company Details

Legal Name: STARGAIT MEDFORD PHYSICAL THERAPY, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: February 21st 2020
Date of Dissolution: July 3rd 2025
Expiration date: 28 Feb 2025
UBI Number: 604 579 276
ZIP code: 98685
City: Vancouver
County: CLARK
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1308 NE 134TH ST, 110, VANCOUVER, WA, 98685-2726, UNITED STATES

Contact Details

E-Mail: DESUN14@GMAIL.COM
Phone Number: +1 541-292-4244

Nature of Business

Other Services, PHYSICAL THERAPY

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Registered Agent Information

Name Role Address
AXIOM ADVISORY GROUP Registered Agent 16420 SE MCGILLIVRAY BLVD STE 103-1005, VANCOUVER, WA, 98683-3461, UNITED STATES

Key Officers & Management

Name Role Address
DENISE WENTZEL Executor 16420 SE MCGILLIVRAY BLVD, SUITE 355, VANCOUVER, WA, 98683-3461, UNITED STATES
DENISE WENTZEL Governing Person -
OLIVER MANTILLA Governing Person -
CHRISTIAN CERDAN Governing Person -

National Provider Identifier

NPI Number:
1841824471
Certification Date:
2020-02-21

Authorized Person:

Name:
MRS. DENISE A WENTZEL
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
163WH0200X - Home Health Registered Nurse
Is Primary:
No
Selected Taxonomy:
163WP0200X - Pediatric Registered Nurse
Is Primary:
No
Selected Taxonomy:
224ZF0002X - Feeding, Eating & Swallowing Occupational Therapy Assistant
Is Primary:
No
Selected Taxonomy:
2251P0200X - Pediatric Physical Therapist
Is Primary:
No
Selected Taxonomy:
225X00000X - Occupational Therapist
Is Primary:
No
Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
Yes

Contacts:

Fax:
8558408203
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