Provider Demographics
NPI:1649719949
Name:WANDA'S HEALTH MASSAGE THERAPY
Entity type:Organization
Organization Name:WANDA'S HEALTH MASSAGE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:803-873-7388
Mailing Address - Street 1:2146 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6014
Mailing Address - Country:US
Mailing Address - Phone:910-632-0330
Mailing Address - Fax:888-965-9470
Practice Address - Street 1:429 PERSON ST STE 1-A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5737
Practice Address - Country:US
Practice Address - Phone:910-632-0330
Practice Address - Fax:888-965-9470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSSLADY CORPORATE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-20
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17329OtherNCBMBT