OLYMPIC SPINE AND SPORTS THERAPY, P.C.

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Company Details

Legal Name:	OLYMPIC SPINE AND SPORTS THERAPY, P.C.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	December 29th 1999
Expiration date:	31 Dec 2025
UBI Number:	602 002 145
ZIP code:	98043
City:	Mountlake Terrace
County:	SNOHOMISH
Home State:	WASHINGTON
Principal Office Street Address:	6603 220TH ST SW STE 102, MOUNTLAKE TER, WA, 98043-2186, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$1,197

Contact Details

E-Mail:

THAYER@CARNEYLAW.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
MARK SHELLEY	Registered Agent	6603 220TH ST SW STE 102, MOUNTLAKE TER, WA, 98043-2186, UNITED STATES

Key Officers & Management

Name	Role
MARK SHELLEY	Governing Person

National Provider Identifier

NPI Number:

1629250980

Link:

View on NPI website

Authorized Person:

Name:

LEE SHELLEY

Role:

OFFICE MANAGER

Phone:

4257742411

Taxonomy:

Selected Taxonomy:

111N00000X - Chiropractor

Is Primary:

Yes

Contacts:

Phone:

+1 425-774-2411

Fax:

4256727065

Form 5500 Series

Employer Identification Number (EIN):

911994454

Plan Year:

2023

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

4257742411

File:

Plan Administrator / Signatory:

KEVIN BOERCKER(Plan administrator)

Plan Year:

2022

Number Of Participants:

16

Plan Name:

401(K)

Sponsor's telephone number:

4257742411

File:

Plan Administrator / Signatory:

LEEANNE SHELLEY(Plan administrator) LEEANNE SHELLEY(Employer/plan sponsor)

Plan Year:

2021

Number Of Participants:

13

Plan Name:

401(K)

Sponsor's telephone number:

4257742411

File:

Plan Administrator / Signatory:

LEEANNE SHELLEY(Plan administrator) LEEANNE SHELLEY(Employer/plan sponsor)

Plan Year:

2020

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

4257742411

File:

Plan Administrator / Signatory:

LEEANNE SHELLEY(Plan administrator) LEEANNE SHELLEY(Employer/plan sponsor)

Plan Year:

2019

Number Of Participants:

12

Plan Name:

401(K)

Sponsor's telephone number:

4257742411

File:

Plan Administrator / Signatory:

LEEANNE SHELLEY(Plan administrator) LEEANNE SHELLEY(Employer/plan sponsor)

Paycheck Protection Program

Jobs Reported:

15

Initial Approval Amount:

$178,387

Date Approved:

2020-04-08

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$178,387

Race:

Unanswered

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$179,833.65

Servicing Lender:

Heritage Bank

Use of Proceeds:

Payroll: $178,387

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