MEDICARE: WANDA'S HEALTH MASSAGE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17329	OTHER	NC	NCBMBT

General Provider Information

NPI Number	:	1649719949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDA'S HEALTH MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	2146 HERITAGE WAY
Second Line	:
City	:	CAMERON
State	:	NC
Zip	:	28326-6014
Country	:	US
Telephone Number	:	910-632-0330
Fax Number	:	888-965-9470

Provider Business Practice Location Address
First Line	:	429 PERSON ST STE 1-A
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5737
Country	:	US
Telephone Number	:	910-632-0330
Fax Number	:	888-965-9470

Authorized Official
Title or Position	:	OWNER
Name	:	WANDA LARRIE NAYEEMA ARCHIE-RAHEEM
Credential	:	CMT
Telephone Number	:	803-873-7388

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	09/02/2025

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