Provider Demographics
NPI:1760523229
Name:PREBOSKI, ZACHARY LUKE (MS LPC, MS PT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LUKE
Last Name:PREBOSKI
Suffix:
Gender:M
Credentials:MS LPC, MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 S ABBS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1621
Mailing Address - Country:US
Mailing Address - Phone:608-333-5272
Mailing Address - Fax:
Practice Address - Street 1:8150 W EMERALD ST STE 180
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9019
Practice Address - Country:US
Practice Address - Phone:208-450-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10386-024225100000X
IDLPC-10464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10386-024OtherPHYSICAL THERAPIST