Healthcare Provider Details

I. General information

NPI: 1144197260
Provider Name (Legal Business Name): CROSS THE LINE PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 JACKSON AVE STE 102
WINTER PARK FL
32789-4673
US

IV. Provider business mailing address

750 JACKSON AVE STE 102
WINTER PARK FL
32789-4673
US

V. Phone/Fax

Practice location:
  • Phone: 407-710-5388
  • Fax:
Mailing address:
  • Phone: 407-710-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON REGRUIT
Title or Position: OWNER
Credential: PT, DPT, ATC, CSCS
Phone: 585-362-1433