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Moss Physical Therapy LLC

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Company Details

Name: Moss Physical Therapy LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 13 May 2021 (4 years ago)
Financial Date End: 31 May 2025
Entity Number: 4282809
Place of Formation: IDAHO
File Number: 763482
ZIP code: 83714
County: Ada County
Principal Address: 5865 W HIDDEN SPRINGS DR BOISE, ID 83714
Mailing Address: 5865 W HIDDEN SPRINGS DR BOISE, ID 83714-9464

Agent

Name Role Address
Mark L Moss Agent 1888 N ANNADALE WAY, EAGLE, ID 83616

Member

Name Role Address Appointed On
Mark L Moss Member 4630 W. FARM VIEW DR., BOISE, ID 83714 2022-05-18

National Provider Identifier

NPI Number:
1184297111
Certification Date:
2024-11-20

Authorized Person:

Name:
MARK LEE MOSS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
No
Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Amendment to Certificate 0005902918 2024-09-17
Annual Report 0005667286 2024-04-03
Annual Report 0005194091 2023-04-10
Annual Report 0004751320 2022-05-18
Initial Filing 0004282809 2021-05-13

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Date of last update: 19 May 2025

Sources: Idaho Secretary of State