Healthcare Provider Details

I. General information

NPI: 1235040478
Provider Name (Legal Business Name): IRYNA RODYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 VIKING DR STE 66
EDEN PRAIRIE MN
55344-4560
US

IV. Provider business mailing address

15677 FINEWOOD CT
APPLE VALLEY MN
55124-5819
US

V. Phone/Fax

Practice location:
  • Phone: 763-357-8025
  • Fax:
Mailing address:
  • Phone: 763-568-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26032119
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: