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NPI Code Detail

MEDICARE: EMILY HELEN CRISLER-WINARTA PA-C, ATC

MEDICARE: EMILY HELEN CRISLER-WINARTA PA-C, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerATR-009043AZ
2363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12000034453OTHERBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
2ATR-009043OTHERAZARIZONA BOARD OF ATHLETIC TRAINING

General Provider Information

NPI Number : 1811562275
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY HELEN CRISLER-WINARTA PA-C, ATC
Provider Business Mailing Address
First Line : 3100 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2637
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3100 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2637
Country : US
Telephone Number : 602-812-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2021
Last Update Date : 01/14/2026

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