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General NPI Number Information
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NPI Number | 1487598512
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Entity Type | Organization
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Legal Business Name | GOLD COAST PHYSIO, LLC
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 100 DECKER RD
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City | WALLED LAKE
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State | MI
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Zip | 48390-3625
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Country | US
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Telephone | 248-896-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 631 ANHINGA DR
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City | EAST LANSING
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State | MI
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Zip | 48823-8364
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Country | US
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Telephone | 248-918-8300
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | NARMEAN PEDAWI
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Credential | OTR/L
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Telephone | 248-918-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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