Healthcare Provider Details

I. General information

NPI: 1033888375
Provider Name (Legal Business Name): BRIDGE TO RESTORATION THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FULLER AVE NE STE 208
GRAND RAPIDS MI
49505-3458
US

IV. Provider business mailing address

3373 SANDYHOOK CT SE
KENTWOOD MI
49512-5281
US

V. Phone/Fax

Practice location:
  • Phone: 616-885-2476
  • Fax: 616-383-9009
Mailing address:
  • Phone: 616-885-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. HASINA J BANKSTON
Title or Position: OWNER
Credential: LMSW
Phone: 616-885-2476