Provider Demographics
NPI:1811562275
Name:CRISLER, EMILY HELEN (ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HELEN
Last Name:CRISLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:HELEN
Other - Last Name:CRISLER-WINARTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:2300 W PECOS RD APT 332
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-0815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1535
Practice Address - Country:US
Practice Address - Phone:480-829-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0090432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000034453OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
AZATR-009043OtherARIZONA BOARD OF ATHLETIC TRAINING