MEDICARE: MS. IBANI BRIDGEFORD RMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	R03749	MD

General Provider Information

NPI Number	:	1417833054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IBANI BRIDGEFORD RMP

Provider Business Mailing Address
First Line	:	3505 ELLICOTT MILLS DR STE B1
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4599
Country	:	US
Telephone Number	:	443-203-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 ELLICOTT MILLS DR STE B1
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4599
Country	:	US
Telephone Number	:	443-203-8308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	10/06/2025

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