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IDAHO PHYSICAL REHABILITATION LLC

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Company Details

Name: IDAHO PHYSICAL REHABILITATION LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 24 Jan 2020 (5 years ago)
Financial Date End: 31 Jan 2026
Date dissolved: 26 Apr 2025
Entity Number: 3753944
Place of Formation: IDAHO
File Number: 696330
ZIP code: 83638
County: Valley County
Mailing Address: TARA OSBORNE 13762 NISULA RD MCCALL, ID 83638-5072
Principal Address: TARA OSBORNE 100 N 3RD ST MCCALL, ID 83638-4401

Agent

Name Role Address
TARA OSBORNE Agent 300 STIBNITE, UNIT 1, MCCALL, ID 83638

Manager

Name Role Address Appointed On
TARA OSBORNE Manager 13762 NISULA RD, MCCALL, ID 83638 2021-03-24

National Provider Identifier

NPI Number:
1588333256
Certification Date:
2025-02-11

Authorized Person:

Name:
TARA OSBORNE
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
2083295807

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0006321789 2025-06-17
Dissolution/Revocation - Administrative 0006219438 2025-04-26
Annual Report 0005524355 2023-12-21
Annual Report 0005020176 2022-12-08
Amendment to Certificate 0005020191 2022-12-08

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State