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Organization
JLC REHAB, INC.
Active
Organization
JLC REHAB, INC.
Active
Other names
INDIGO PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR J. KLIXBULL DPT (PARTNER)
(843) 357-4039
Entity
Organization
Contact information
Practice address
11931 PLAZA DR, MURRELLS INLET, SC 29576-9356
(843) 357-4039
(843) 357-4227
Mailing address
11931 PLAZA DR, PO BOX 1795, MURRELLS INLET, SC 29576-9356
(843) 357-4039
(843) 357-4227
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5347
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2523
—
SC
Enumeration date
03/16/2006
Last updated
05/21/2008
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