Provider Demographics
NPI:1508548371
Name:SUMMIT PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:VOLLERTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-644-7722
Mailing Address - Street 1:2219 COUNTY ROAD 220 STE 304
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-7778
Mailing Address - Country:US
Mailing Address - Phone:904-644-7722
Mailing Address - Fax:
Practice Address - Street 1:1305 N ORANGE AVE STE 118
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-2553
Practice Address - Country:US
Practice Address - Phone:904-531-5500
Practice Address - Fax:904-637-1532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy