Provider Demographics
NPI:1114027778
Name:KLIXBULL, EDGAR JAMES (DPT, OCS, CSCS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:JAMES
Last Name:KLIXBULL
Suffix:
Gender:M
Credentials:DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N KINGS HWY STE E
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2326
Mailing Address - Country:US
Mailing Address - Phone:843-839-4900
Mailing Address - Fax:843-604-2857
Practice Address - Street 1:5900 N KINGS HWY STE E
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2326
Practice Address - Country:US
Practice Address - Phone:843-839-4900
Practice Address - Fax:843-604-2857
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist