MEDICARE: AILEEN MARIE MCKERNAN

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
1	225100000X	Physical Therapist	2305206297	VA

General Provider Information

NPI Number	:	1487981122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN MARIE MCKERNAN

Provider Business Mailing Address
First Line	:	226 BURNET ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-6196
Country	:	US
Telephone Number	:	434-981-2701
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 SEMINOLE TRL
Second Line	:	SUITE 108
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-1505
Country	:	US
Telephone Number	:	434-985-2198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	05/26/2017

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