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HomeGrown Pediatric Therapies, LLC

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Company Details

Name: HomeGrown Pediatric Therapies, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Oct 2024 (10 months ago)
Financial Date End: 31 Oct 2025
Entity Number: 5946695
Place of Formation: IDAHO
File Number: 960336
ZIP code: 83402
County: Bonneville County
Principal Address: 8000 S 55TH W IDAHO FALLS, ID 83402

Agent

Name Role Address
ROSS GARDNER Agent 8000 S 55TH W, IDAHO FALLS, ID 83402

National Provider Identifier

NPI Number:
1992690101
Certification Date:
2025-06-24

Authorized Person:

Name:
ROSS GARDNER
Role:
OWNER, PHYSICAL THERAPIST
Phone:

Taxonomy:

Selected Taxonomy:
224Z00000X - Occupational Therapy Assistant
Is Primary:
No
Selected Taxonomy:
2251P0200X - Pediatric Physical Therapist
Is Primary:
No
Selected Taxonomy:
225200000X - Physical Therapy Assistant
Is Primary:
No
Selected Taxonomy:
225X00000X - Occupational Therapist
Is Primary:
No
Selected Taxonomy:
2355S0801X - Speech-Language Assistant
Is Primary:
No

Contacts:

Fax:
8438928444

Filing

Filing Name Filing Number Filing date
Initial Filing 0005946695 2024-10-16

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Date of last update: 24 Aug 2025

Sources: Idaho Secretary of State