=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235040478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRYNA RODYCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10260 VIKING DR STE 66
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-357-8025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15677 FINEWOOD CT
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55124-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-568-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 26032119
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------