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Palisade Physical Therapy & Wellness Services PLLC

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Company Details

Name: Palisade Physical Therapy & Wellness Services PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Jun 2024 (a year ago)
Financial Date End: 30 Jun 2026
Entity Number: 5792333
Place of Formation: IDAHO
File Number: 943924
ZIP code: 83401
County: Bonneville County
Principal Address: 3649 E GAMPLE AVE #4 IDAHO FALLS, ID 83401
Mailing Address: 329 LEMMON LN RIGBY, ID 83442

Agent

Name Role Address
Bryant Gardner Agent 329 LEMMON LN, RIGBY, ID 83442

Manager

Name Role Address Appointed On
Bryant Gardner Manager 329 LEMMON LN, RIGBY, ID 83442 2025-07-01

National Provider Identifier

NPI Number:
1518705441
Certification Date:
2024-09-09

Authorized Person:

Name:
BRYANT GARDNER
Role:
OWNER/PRACTICING THERAPIST
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006333685 2025-07-01
Initial Filing 0005792333 2024-06-29

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Date of last update: 23 Aug 2025

Sources: Idaho Secretary of State