MEDICARE: EXERCISENOW VITALPATH CLINIC, INC

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	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1487529798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXERCISENOW VITALPATH CLINIC, INC

Provider Business Mailing Address
First Line	:	4830 KNIGHTSBRIDGE BLVD STE K
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2300
Country	:	US
Telephone Number	:	614-612-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 KNIGHTSBRIDGE BLVD STE K
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2300
Country	:	US
Telephone Number	:	614-612-0230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WISLER SAINT-VIL
Credential	:	MD
Telephone Number	:	614-612-0230

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	03/19/2026

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