Individual
CRYSTAL NICHOLS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
4968 BETHANY RD, RUSTBURG, VA 24588-3693
(434) 845-3554
Mailing address
4968 BETHANY RD, RUSTBURG, VA 24588-3693
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001767
VA
Other
Enumeration date
12/15/2009
Last updated
12/15/2009
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