Individual provider Active NPI

Wanda Larrie Nayeema Archie-Raheem, CMT

  • Massage Therapist
  • Fayetteville, NC
National Provider Identifier
1790167690
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
17329 Issued in NC
Practice address
115 S Cool Spring St Ste 1-a
Fayetteville, NC 28301-5723
Phone
(803) 873-7388
Fax
(888) 965-9470
NPI assigned
Jun 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 17329 NC Primary

Addresses

Primary practice location

115 S Cool Spring St Ste 1-a
Fayetteville, NC 28301-5723

Mailing address

115 S Cool Spring St
Fayetteville, NC 28301-5723
Phone (803) 873-7388

Other practice location 1

429 Person St Ste 1
Fayetteville, NC 28301-5737
Phone (803) 873-7388

Other identifiers 1

IdentifierTypeStateIssuer
17329OtherNCNCBTMB

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
17329NCMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bosslady Massage & Bodywork Therapy LLC Massage Therapist Current Accepting new patients
Bosslady Corporate Services LLC Massage Therapist CurrentSince Jun 16, 2024 Accepting new patients
Wanda'S Health Massage Therapy Massage Therapist CurrentSince Jun 23, 2024 Accepting new patients

Locations

115 S Cool Spring St
Ste 1A
Fayetteville, NC 28301

115 S Cool Spring St
Fayetteville, NC 28301

429 Person St
Ste 1A
Fayetteville, NC 28301
Phone (803) 873-7388

1030 Saint Andrews Rd
Ste B3
Columbia, SC 29210

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1790167690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 S COOL SPRING ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015723",
            "telephone_number": "803-873-7388",
            "fax_number": "888-965-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S COOL SPRING ST STE 1-A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015723",
            "telephone_number": "803-873-7388",
            "fax_number": "888-965-9470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "429 Person St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283015737",
            "country_code": "US",
            "telephone_number": "803-873-7388",
            "fax_number": "888-965-9470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ARCHIE-RAHEEM",
        "first_name": "WANDA",
        "middle_name": "LARRIE NAYEEMA",
        "credential": "CMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-26",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NC",
            "license": "17329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBTMB",
            "identifier": "17329",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.