Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Crystal Nichols Clark, LPTA

Individual provider Physical Therapy Assistant · NPI 1104155480

Crystal Nichols Clark, LPTA is a Physical Therapy Assistant in Rustburg, Virginia. Licensed in Virginia. Registered with an NPI since 2009.

Licensed in
VA
In the registry since
2009
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Practice location Address checks out

4968 Bethany Rd
Rustburg, VA 24588-3693
Phone: (434) 845-3554
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 2306001767 (VA)

Record details

NPI number1104155480
Entity typeIndividual (Type 1)
GenderFemale
Credentials LPTA
Sole proprietorNo
NPI enumeratedDecember 15, 2009
Last updated in NPPESDecember 15, 2009

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