NPIMap

Organization Active NPI

Trifecta Therapeutics, LLC

  • Sports Physical Therapist
  • Glassboro, NJ
National Provider Identifier
1841701141
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
40QA01529700 Issued in NJ
Legal business name
TRIFECTA THERAPEUTICS, LLC
Practice address
107 Rowan Blvd
Glassboro, NJ 08028-2203
Phone
(856) 347-0333
Fax
(856) 230-7164
NPI assigned
Oct 13, 2017
Last updated
Mar 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Authorized official

Name
Dr. Jeremy Boyd, PT, DPT, OCS, SCSNPI 1407273642
Title
Owner/Ceo
Phone
(856) 347-0333

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA01529700 NJ
Sports Physical Therapist 2251S0007X 40QA01529700 NJ Primary
Orthopedic Physical Therapist 2251X0800X 40QA01529700 NJ

Addresses

Primary practice location

107 Rowan Blvd
Glassboro, NJ 08028-2203

Mailing address

75 Village Green LN
Sicklerville, NJ 08081-1629
Phone (917) 885-1760

Other practice location 1

102 High St W
Glassboro, NJ 08028-2524
Phone (856) 347-0333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180102001142 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4789942483 Receives reassigned benefits from 10 practitioners
Practice locations: Glassboro, NJ

National Provider Directory

National Provider Directory

Locations

2060 Springdale Rd
Ste 400
Cherry Hill, NJ 08003
Phone (609) 413-6454

102 W High St
Glassboro, NJ 08028
Phone (856) 347-0333

102 W High St
Ste 202
Glassboro, NJ 08028
Phone (917) 885-1760

107 Rowan Blvd
Glassboro, NJ 08028
Phone (856) 347-0333

Practitioners & affiliated clinicians

Practitioners 10

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": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1841701141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 VILLAGE GREEN LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811629",
            "telephone_number": "917-885-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 ROWAN BLVD",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282203",
            "telephone_number": "856-347-0333",
            "fax_number": "856-230-7164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 High St W",
            "address_purpose": "LOCATION",
            "city": "Glassboro",
            "state": "NJ",
            "postal_code": "080282524",
            "country_code": "US",
            "telephone_number": "856-347-0333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRIFECTA THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2021-03-15",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "856-347-0333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, OCS, SCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01529700",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NJ",
            "license": "40QA01529700",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NJ",
            "license": "40QA01529700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glassboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.