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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