Provider Demographics
NPI:1215137476
Name:ZBARASCHUK, KOREY I (PT)
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:ZBARASCHUK
Suffix:I
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 N STOKESBERRY PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5035
Mailing Address - Country:US
Mailing Address - Phone:208-884-8323
Mailing Address - Fax:208-855-5708
Practice Address - Street 1:2470 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5035
Practice Address - Country:US
Practice Address - Phone:208-884-8323
Practice Address - Fax:208-855-5708
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32375225100000X
IDPT-1233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT323750Medicare PIN
CAZZZ23993ZMedicare PIN