Provider Demographics
NPI:1952395527
Name:PILARSKI, BRIAN MATTHEW (LAT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:PILARSKI
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 E ADA ST
Mailing Address - Street 2:
Mailing Address - City:FRANCESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47946-8319
Mailing Address - Country:US
Mailing Address - Phone:219-567-9187
Mailing Address - Fax:
Practice Address - Street 1:616 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1117
Practice Address - Country:US
Practice Address - Phone:574-946-2157
Practice Address - Fax:574-946-2110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000522A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151305Medicare ID - Type Unspecified