Healthcare Provider Details

I. General information

NPI: 1649719949
Provider Name (Legal Business Name): WANDA'S HEALTH MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 PERSON ST STE 1-A
FAYETTEVILLE NC
28301-5737
US

IV. Provider business mailing address

115 S COOL SPRING ST STE 1-A
FAYETTEVILLE NC
28301-5723
US

V. Phone/Fax

Practice location:
  • Phone: 910-632-0330
  • Fax: 888-965-9470
Mailing address:
  • Phone: 910-632-0330
  • Fax: 888-965-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA LARRIE NAYEEMA ARCHIE-RAHEEM
Title or Position: OWNER
Credential: CMT
Phone: 803-873-7388