Provider Demographics
NPI:1184124372
Name:REGRUIT, JASON W (PT, DPT, MS, CSCS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:REGRUIT
Suffix:
Gender:M
Credentials:PT, DPT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 STONE GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4094
Mailing Address - Country:US
Mailing Address - Phone:585-362-1433
Mailing Address - Fax:
Practice Address - Street 1:99 WOLF CREEK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4968
Practice Address - Country:US
Practice Address - Phone:302-734-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003899225100000X
VA2305214117225100000X
DEJ1-0003876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist