Provider Demographics
NPI:1871808592
Name:PREBLE, LUCAS A (DPT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:A
Last Name:PREBLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 COPPERTOP LOOP NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3647
Mailing Address - Country:US
Mailing Address - Phone:206-842-2428
Mailing Address - Fax:206-842-2890
Practice Address - Street 1:9419 COPPERTOP LOOP NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3647
Practice Address - Country:US
Practice Address - Phone:206-842-2428
Practice Address - Fax:206-842-2890
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60177354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0269014OtherL&I
WAP01106205OtherRR MEDICARE
ORG8912002Medicare PIN
WAG8894460Medicare PIN