Healthcare Provider Details

I. General information

NPI: 1265115919
Provider Name (Legal Business Name): CROSSOVER PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W ERNA DR
TAMPA FL
33603-2804
US

IV. Provider business mailing address

1707 W ERNA DR
TAMPA FL
33603-2804
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYANT CARL VILLOTA
Title or Position: FOUNDER/CEO
Credential: DPT, MBA, ATC
Phone: 561-602-3695