Healthcare Provider Details

I. General information

NPI: 1790302115
Provider Name (Legal Business Name): HOPE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N KINGS HWY STE E
MYRTLE BEACH SC
29577-2326
US

IV. Provider business mailing address

5900 N KINGS HWY STE E
MYRTLE BEACH SC
29577-2326
US

V. Phone/Fax

Practice location:
  • Phone: 630-913-1820
  • Fax:
Mailing address:
  • Phone: 843-839-4900
  • Fax: 843-604-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CANDACE KLIXBULL
Title or Position: OWNER
Credential:
Phone: 630-913-1820