Provider Demographics
NPI:1437029303
Name:WRIGLEYVILLE THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:WRIGLEYVILLE THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:872-240-3760
Mailing Address - Street 1:3300 N CLARK ST
Mailing Address - Street 2:LOFT 9
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1604
Mailing Address - Country:US
Mailing Address - Phone:872-240-3760
Mailing Address - Fax:
Practice Address - Street 1:3300 N CLARK ST
Practice Address - Street 2:LOFT 9
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1604
Practice Address - Country:US
Practice Address - Phone:872-240-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty