MEDICARE: ALLISON MARIE FLORENTINO ATC, PA-S

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
1	390200000X	Student in an Organized Health Care Education/Training Program		MA
2	2255A2300X	Athletic Trainer	ATL22382	MA

General Provider Information

NPI Number	:	1023518230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARIE FLORENTINO ATC, PA-S

Provider Business Mailing Address
First Line	:	155 ARARAT ST APT 106
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-3456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SALISBURY ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1265
Country	:	US
Telephone Number	:	508-767-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	01/05/2026

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