Provider Demographics
NPI:1043013485
Name:PILAK, CALLI (MS, LAT, ATC, CISSN)
Entity type:Individual
Prefix:
First Name:CALLI
Middle Name:
Last Name:PILAK
Suffix:
Gender:
Credentials:MS, LAT, ATC, CISSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 ROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7226
Mailing Address - Country:US
Mailing Address - Phone:262-875-8670
Mailing Address - Fax:
Practice Address - Street 1:5477 S WESTRIDGE CT
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7951
Practice Address - Country:US
Practice Address - Phone:262-875-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1647-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer