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PRO FORM PHYSICAL THERAPY P.C.

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Company Details

Name: PRO FORM PHYSICAL THERAPY P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 05 Jun 2013 (12 years ago)
Entity Number: 4413520
ZIP code: 10453
County: Queens
Place of Formation: New York
Address: 1975, Br, NY, United States, 10453
Principal Address: 1975, B, NY, United States, 10453

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
SAM HANNA DOS Process Agent 1975, Br, NY, United States, 10453

Chief Executive Officer

Name Role Address
SAM HANNA Chief Executive Officer 1975 UNIVERSITY A, BR, NY, United States, 10453

National Provider Identifier

NPI Number:
1740621697

Authorized Person:

Name:
SAM HANNA
Role:
OWNER/PHYSICAL THERAPIST
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
No
Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
7185344135

History

Start date End date Type Value
2025-02-27 2025-06-11 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-01-06 2025-02-27 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2013-06-05 2023-01-06 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
221026002764 2022-10-26 BIENNIAL STATEMENT 2021-06-01
130605000753 2013-06-05 CERTIFICATE OF INCORPORATION 2013-06-05

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$37,675
Date Approved:
2021-02-20
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$37,675
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$37,925.12
Servicing Lender:
TD Bank, National Association
Use of Proceeds:
Payroll: $37,670
Utilities: $1
Jobs Reported:
3
Initial Approval Amount:
$33,945
Date Approved:
2020-04-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$33,945
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$34,303.31
Servicing Lender:
TD Bank, National Association
Use of Proceeds:
Payroll: $33,945

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State