Provider Demographics
NPI:1487677183
Name:KERNODLE, TRISHA M (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:M
Last Name:KERNODLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:M
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1821
Mailing Address - Country:US
Mailing Address - Phone:203-257-0719
Mailing Address - Fax:
Practice Address - Street 1:3001 EDWARDS MILL RD # 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5243
Practice Address - Country:US
Practice Address - Phone:919-781-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008481225100000X
NC10911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504223OtherMEDICARE INDIVIDUAL PTAN