Healthcare Provider Details

I. General information

NPI: 1184124372
Provider Name (Legal Business Name): JASON W REGRUIT PT, DPT, MS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5934
US

IV. Provider business mailing address

8770 MAITLAND SUMMIT BLVD UNIT 2414
ORLANDO FL
32810-6017
US

V. Phone/Fax

Practice location:
  • Phone: 585-362-1433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7618
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT38613
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT38613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: