Provider Demographics
NPI:1023518230
Name:FLORENTINO, ALLISON MARIE (ATC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 PACKARD ST # 3T
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6385
Mailing Address - Country:US
Mailing Address - Phone:617-283-7610
Mailing Address - Fax:
Practice Address - Street 1:1087 STARK RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3537
Practice Address - Country:US
Practice Address - Phone:617-283-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT08082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer