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NPI Code Detail

MEDICARE: JACOB JOHN KMIECIK DPT

MEDICARE: JACOB JOHN KMIECIK DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT60852959WA

General Provider Information

NPI Number : 1578043089
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB JOHN KMIECIK DPT
Provider Business Mailing Address
First Line : 5450 LEARY AVE NW APT 643
Second Line :
City : SEATTLE
State : WA
Zip : 98107-4081
Country : US
Telephone Number : 402-350-3146
Fax Number :
Provider Business Practice Location Address
First Line : 1218 3RD AVE STE 104
Second Line :
City : SEATTLE
State : WA
Zip : 98101-3008
Country : US
Telephone Number : 206-447-2220
Fax Number : 206-447-2228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2018
Last Update Date : 08/15/2018

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Directions to “ JACOB JOHN KMIECIK DPT” Practice Location

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