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Pocatello Physical Therapy PLLC

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Company Details

Name: Pocatello Physical Therapy PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Jul 2019 (6 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 3563630
Place of Formation: IDAHO
File Number: 673034
ZIP code: 83201
County: Bannock County
Principal Address: STE D2 333 N 18TH AVE POCATELLO, ID 83201-3358

Agent

Name Role Address
Janae Lawver Agent 333 N 18TH AVE, STE D2, POCATELLO, ID 83201

Member

Name Role Address Appointed On
Randy C Sidwell Member 333 N. 18TH AVE, POCATELLO, ID 83201 2020-07-03

National Provider Identifier

NPI Number:
1548808637
Certification Date:
2019-12-19

Authorized Person:

Name:
RANDY C. SIDWELL
Role:
OWNER, PT
Phone:

Taxonomy:

Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
Yes

Contacts:

Fax:
2082344805

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0005939268 2024-10-16
Dissolution/Revocation - Administrative 0005936758 2024-10-11
Application for Reinstatement 0005288344 2023-06-20
Dissolution/Revocation - Administrative 0004937149 2022-10-05
Annual Report 0004301267 2021-06-03

USAspending Awards / Financial Assistance

Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
16800.00
Total Face Value Of Loan:
16800.00

Paycheck Protection Program

Jobs Reported:
2
Initial Approval Amount:
$16,800
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$16,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$16,982.27
Servicing Lender:
Glacier Bank
Use of Proceeds:
Payroll: $16,800

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Date of last update: 06 Jul 2025

Sources: Idaho Secretary of State