Healthcare Provider Details

I. General information

NPI: 1154719797
Provider Name (Legal Business Name): HEUSER HEALTH & FITNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MELLWOOD AVE # 197
LOUISVILLE KY
40206-1033
US

IV. Provider business mailing address

1860 MELLWOOD AVE # 197
LOUISVILLE KY
40206-1033
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7833
  • Fax: 502-895-4418
Mailing address:
  • Phone: 502-893-7833
  • Fax: 502-895-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PEGGY JANSON HEUSER
Title or Position: CMO
Credential: APRN
Phone: 502-893-7833