Healthcare Provider Details

I. General information

NPI: 1205775525
Provider Name (Legal Business Name): TRACY ANN MARTORELLO LICENSED MASSAGE THE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 W BELMONT AVE
CHICAGO IL
60657-8496
US

IV. Provider business mailing address

1740 N MAPLEWOOD AVE APT 121
CHICAGO IL
60647-5280
US

V. Phone/Fax

Practice location:
  • Phone: 312-523-5398
  • Fax:
Mailing address:
  • Phone:
  • Fax: 312-523-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.014433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: