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General NPI Number Information
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NPI Number | 1487981122
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Entity Type | Individual
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Provider Name | AILEEN MARIE MCKERNAN
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Gender | Female
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 5924 SEMINOLE TRL SUITE 108
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City | BARBOURSVILLE
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State | VA
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Zip | 22923-1505
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Country | US
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Telephone | 434-985-2198
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Fax |
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Provider Business Mailing Address
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Address Line | 226 BURNET ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-6196
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Country | US
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Telephone | 434-981-2701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206297
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License Number State | VA
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