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EAGLE ROCK PHYSICAL THERAPY, PLLC

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Company Details

Name: EAGLE ROCK PHYSICAL THERAPY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 17 Mar 2014 (11 years ago)
Financial Date End: 31 Mar 2025
Date dissolved: 07 Jun 2025
Entity Number: 414001
Place of Formation: IDAHO
File Number: 414001
ZIP code: 83404
County: Bonneville County
Principal Address: 2107 E 49TH S IDAHO FALLS, ID 83404-7655

Agent

Name Role Address
JACOB ROBERTS Agent 2107 E 49TH, IDAHO FALLS, ID 83404

Manager

Name Role Address Appointed On
Marisa R Roberts Manager 2107 E 49TH SO, IDAHO FALLS, ID 83404 2021-09-21

National Provider Identifier

NPI Number:
1649449430

Authorized Person:

Name:
DR. JACOB B ROBERTS
Role:
OWNER/PROVIDER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0006303694 2025-06-07
Application for Reinstatement 0005811860 2024-07-08
Dissolution/Revocation - Administrative 0005774934 2024-06-12
Application for Reinstatement 0005364087 2023-08-15
Dissolution/Revocation - Administrative 0005280313 2023-06-14

Paycheck Protection Program

Jobs Reported:
6
Initial Approval Amount:
$64,100
Date Approved:
2020-04-14
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$64,100
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$64,793.68
Servicing Lender:
Zions Bank, A Division of
Use of Proceeds:
Payroll: $64,100

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Date of last update: 21 Jul 2025

Sources: Idaho Secretary of State