MEDICARE: ZACHARY LUKE PREBOSKI MS LPC, MS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-6012	ID
2	101YM0800X	Mental Health Counselor	LPC-10464	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10386-024	OTHER	WI	PHYSICAL THERAPIST
2	LPC-10464	OTHER	ID	PROFESSIONAL COUNSELOR
3	PT-6012	OTHER	ID	PHYSICAL THERAPIST

General Provider Information

NPI Number	:	1760523229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY LUKE PREBOSKI MS LPC, MS PT

Provider Business Mailing Address
First Line	:	490 S ABBS ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-1621
Country	:	US
Telephone Number	:	608-333-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W BOBWHITE CT STE 240
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-6656
Country	:	US
Telephone Number	:	208-450-5645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	05/12/2026

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