Healthcare Provider Details

I. General information

NPI: 1114805512
Provider Name (Legal Business Name): TRIFECTA SPORTS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 TIMBER HILL CT
CHARLOTTE NC
28226-3700
US

IV. Provider business mailing address

11120 TIMBER HILL CT
CHARLOTTE NC
28226-3700
US

V. Phone/Fax

Practice location:
  • Phone: 704-241-3397
  • Fax:
Mailing address:
  • Phone: 704-241-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CARY EDGAR
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-206-6240