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Individual
KEITH JASON KMIECZAK
Active
Individual
KEITH JASON KMIECZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013342L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1360739
BLUE SHIELD
PA
01
—
2053032000
INDEPENDENCE BLUE SHIELD
PA
01
—
2719587
AETNA
PA
01
—
50017328
CAPITAL BLUE CROSS
PA
01
—
814494
FIRST PRIORITY
PA
Enumeration date
11/18/2005
Last updated
08/05/2026
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