Healthcare Provider Details

I. General information

NPI: 1023518230
Provider Name (Legal Business Name): ALLISON MARIE FLORENTINO ATC, PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SALISBURY ST
WORCESTER MA
01609-1265
US

IV. Provider business mailing address

155 ARARAT ST APT 106
WORCESTER MA
01606-3456
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL22382
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: