NPIMap

Organization Active NPI

Summit Physical Therapy, PLLC

  • Physical Therapist
  • Middleburg, FL
National Provider Identifier
1992348569
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SUMMIT PHYSICAL THERAPY, PLLC
Practice address
2219 County Road 220 Ste 304
Middleburg, FL 32068-7778
Phone
(360) 707-8107
NPI assigned
Oct 25, 2019
Last updated
May 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tara Reeves VollertsenNPI 1144363680
Title
Owner
Phone
(360) 707-8107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2219 County Road 220 Ste 304
Middleburg, FL 32068-7778

Mailing address

2379 Carolina Cherry CT
Fleming Island, FL 32003-3373
Phone (360) 707-8107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200226000194 FL Part B Supplier - Clinic/Group Practice 7416384763 Receives reassigned benefits from 15 practitioners
Practice locations: Middleburg, FL; Orange Park, FL; Jacksonville, FL; Green Cove Springs, FL
O20250821003434 FL DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 7416384763 Practice locations: Orange Park, FL

National Provider Directory

National Provider Directory
Tax ID family
Summit Physical Therapy PLL6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2219 County Road 220
Middleburg, FL 32068
Phone (904) 644-7722

2219 County Road 220
Ste 304
Middleburg, FL 32068
Phone (360) 707-8107

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1992348569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2379 CAROLINA CHERRY CT",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320033373",
            "telephone_number": "360-707-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 COUNTY ROAD 220 STE 304",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320687778",
            "telephone_number": "360-707-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "VOLLERTSEN",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "REEVES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-707-8107"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.