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In His Image PT, LLC

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Company Details

Name: In His Image PT, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 30 Apr 2025 (2 months ago)
Financial Date End: 30 Apr 2026
Entity Number: 6235895
Place of Formation: IDAHO
File Number: 992338
ZIP code: 83714
County: Ada County
Principal Address: 10540 N BRIDLE WAY BOISE, ID 83714

Agent

Name Role Address
CHRISTINA V. SPANGBERG Agent 10540 N BRIDLE WAY, BOISE, ID 83714

National Provider Identifier

NPI Number:
1871381061
Certification Date:
2025-04-28

Authorized Person:

Name:
CHRISTINA V SPANGBERG
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2251P0200X - Pediatric Physical Therapist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006235895 2025-04-30

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State