NPIMap

Organization Active NPI

JLC Rehab, Inc.

Doing business as Indigo Physical Therapy

  • Physical Therapist
  • Murrells Inlet, SC
National Provider Identifier
1801865399
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5347 Issued in SC
Legal business name
JLC REHAB, INC.
Doing business as
Indigo Physical Therapy
Practice address
11931 Plaza Dr
Murrells Inlet, SC 29576-9356
Phone
(843) 357-4039
Fax
(843) 357-4227
NPI assigned
Mar 16, 2006
Last updated
May 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

Name
Dr. Edgar J. Klixbull, DPTNPI 1114027778
Title
Partner
Phone
(843) 357-4039

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5347 SC Primary

Addresses

Primary practice location

11931 Plaza Dr
Murrells Inlet, SC 29576-9356

Mailing address

11931 Plaza Dr
PO Box 1795
Murrells Inlet, SC 29576-9356
Phone (843) 357-4039

Other identifiers 1

IdentifierTypeStateIssuer
GP2523MedicaidSC

Other names 1

  • INDIGO PHYSICAL THERAPY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1801865399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11931 PLAZA DR",
            "address_2": "PO BOX 1795",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295769356",
            "telephone_number": "843-357-4039",
            "fax_number": "843-357-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11931 PLAZA DR",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295769356",
            "telephone_number": "843-357-4039",
            "fax_number": "843-357-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLC REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "KLIXBULL",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-357-4039",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2523",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INDIGO PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Murrells Inlet, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.