MEDICARE: EXERCIZE INNOVATIONS

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1558219170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXERCIZE INNOVATIONS

Provider Business Mailing Address
First Line	:	1053 HILL AVE
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-5001
Country	:	US
Telephone Number	:	270-929-0479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1053 HILL AVE
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-5001
Country	:	US
Telephone Number	:	270-929-0479
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON CRANDALL
Credential	:	PH.D.
Telephone Number	:	270-929-0479

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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