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ELLIS PHYSICAL THERAPY AND ASSOCIATES LLC

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Company Details

Name: ELLIS PHYSICAL THERAPY AND ASSOCIATES LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 22 Jul 2019 (6 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 3574109
Place of Formation: IDAHO
File Number: 674085
ZIP code: 83404
County: Bonneville County
Principal Address: 3100 S WOODRUFF AVE IDAHO FALLS, ID 83404
Mailing Address: 3100 S WOODRUFF AVE IDAHO FALLS, ID 83404-8310

Agent

Name Role Address
Porter Clayton Agent 3350 S. 15TH E., IDAHO FALLS, ID 83404

Member

Name Role Address Appointed On
Logan Bradley DPT PC Member 3100 S WOODRUFF AVE, IDAHO FALLS, ID 83404-8310 2022-03-03
Jason Bailey DPT PC Member 3100 S WOODRUFF AVE, IDAHO FALLS, ID 83404-8310 2024-06-03

National Provider Identifier

NPI Number:
1821628645
Certification Date:
2020-01-21

Authorized Person:

Name:
DR. LOGAN BRADLEY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005754666 2024-06-03
Annual Report 0005265616 2023-06-05
Annual Report 0004782120 2022-06-13
Application for Reinstatement 0004632009 2022-03-03
Dissolution/Revocation - Administrative 0004455704 2021-10-21

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State