Healthcare Provider Details

I. General information

NPI: 1487981122
Provider Name (Legal Business Name): AILEEN MARIE MCKERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 SEMINOLE TRL SUITE 108
BARBOURSVILLE VA
22923-1505
US

IV. Provider business mailing address

226 BURNET ST
CHARLOTTESVILLE VA
22902-6196
US

V. Phone/Fax

Practice location:
  • Phone: 434-985-2198
  • Fax:
Mailing address:
  • Phone: 434-981-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: