Healthcare Provider Details

I. General information

NPI: 1992505945
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 COUNTY ROAD 220 STE 304
MIDDLEBURG FL
32068-7778
US

IV. Provider business mailing address

2219 COUNTY ROAD 220 STE 304
MIDDLEBURG FL
32068-7778
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-7722
  • Fax: 904-637-1532
Mailing address:
  • Phone: 904-644-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA REEVES VOLLERTSEN
Title or Position: OWNER
Credential:
Phone: 904-644-7722