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General NPI Number Information
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NPI Number | 1033888375
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Entity Type | Organization
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Legal Business Name | BRIDGE TO RESTORATION THERAPY SERVICES
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 2920 FULLER AVE NE STE 208
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3458
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Country | US
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Telephone | 616-885-2476
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Fax | 616-383-9009
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Provider Business Mailing Address
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Address Line | 3373 SANDYHOOK CT SE
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City | KENTWOOD
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State | MI
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Zip | 49512-5281
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Country | US
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Telephone | 616-885-2476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HASINA J BANKSTON
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Credential | LMSW
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Telephone | 616-885-2476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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