MEDICARE: DR. JASON W REGRUIT PT, DPT, MS, CSCS

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	2255A2300X	Athletic Trainer	AL7618	FL
2	2251S0007X	Sports Physical Therapist	PT38613	FL
3	2251X0800X	Orthopedic Physical Therapist	PT38613	FL

General Provider Information

NPI Number	:	1184124372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON W REGRUIT PT, DPT, MS, CSCS

Provider Business Mailing Address
First Line	:	8770 MAITLAND SUMMIT BLVD UNIT 2414
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-6017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8770 MAITLAND SUMMIT BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-5934
Country	:	US
Telephone Number	:	585-362-1433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	10/22/2025

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