Healthcare Provider Details

I. General information

NPI: 1205750221
Provider Name (Legal Business Name): IRINA RABUSHKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 SLOAN PL STE 250
SAINT PAUL MN
55117-2181
US

IV. Provider business mailing address

4148 146TH AVE NW
ANDOVER MN
55304-3185
US

V. Phone/Fax

Practice location:
  • Phone: 651-771-2012
  • Fax: 651-771-8747
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: