Provider Demographics
NPI:1487981122
Name:MCKERNAN, AILEEN MARIE
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:MARIE
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BURNET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-6196
Mailing Address - Country:US
Mailing Address - Phone:434-981-2701
Mailing Address - Fax:
Practice Address - Street 1:5924 SEMINOLE TRL
Practice Address - Street 2:SUITE 108
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-1505
Practice Address - Country:US
Practice Address - Phone:434-985-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist