Healthcare Provider Details

I. General information

NPI: 1487598512
Provider Name (Legal Business Name): GOLD COAST PHYSIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DECKER RD
WALLED LAKE MI
48390-3625
US

IV. Provider business mailing address

631 ANHINGA DR
EAST LANSING MI
48823-8364
US

V. Phone/Fax

Practice location:
  • Phone: 248-896-1400
  • Fax:
Mailing address:
  • Phone: 248-918-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NARMEAN PEDAWI
Title or Position: OWNER/MANAGER
Credential: OTR/L
Phone: 248-918-8300