Organization Active NPI

Trifecta Sports Rehab LLC

  • Physical Therapist
  • Charlotte, NC
National Provider Identifier
1114805512
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TRIFECTA SPORTS REHAB LLC
Practice address
11120 Timber Hill CT
Charlotte, NC 28226-3700
Phone
(704) 241-3397
NPI assigned
Aug 25, 2025
Last updated
Aug 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Authorized official

Name
Mr. Cary Edgar
Title
Credentialing Manager
Phone
(480) 206-6240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

11120 Timber Hill CT
Charlotte, NC 28226-3700

Mailing address

11120 Timber Hill CT
Charlotte, NC 28226-3700
Phone (704) 241-3397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251217000945 NC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284129354 Receives reassigned benefits from 2 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1114805512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11120 TIMBER HILL CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282263700",
            "telephone_number": "704-241-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 TIMBER HILL CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282263700",
            "telephone_number": "704-241-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIFECTA SPORTS REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-25",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-24",
        "status": "A",
        "authorized_official_last_name": "EDGAR",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-206-6240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.