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General NPI Number Information
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NPI Number | 1508548371
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Entity Type | Organization
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Legal Business Name | SUMMIT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1305 N ORANGE AVE STE 118
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2553
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Country | US
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Telephone | 904-531-5500
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Fax | 904-637-1532
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Provider Business Mailing Address
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Address Line | 2219 COUNTY ROAD 220 STE 304
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City | MIDDLEBURG
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State | FL
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Zip | 32068-7778
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Country | US
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Telephone | 904-644-7722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA REEVES VOLLERTSEN
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Credential |
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Telephone | 904-644-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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