Active NPI
Dimitrios Goulakos, P.T.
- Physical Therapist
- Roslindale, MA
National Provider Identifier
1710104476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8791
- Practice address
- 41 Poplar St
Roslindale, MA 02131-2505 - Phone
- (617) 323-8013
- Fax
- (617) 323-8014
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8791 | MA | Primary |
Addresses
Primary practice location
41 Poplar St
Roslindale, MA 02131-2505
Mailing address
41 Poplar St
Roslindale, MA 02131-2505
Phone (617) 323-8013
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0311847 | Medicaid | MA | |
| Y67509 | Other | MA | BC&BS |
| 37992 | Other | MA | HARVARD PILGRIM |
| 409838 | Other | TUFTS | |
| 0022742 | Other | MA | NEIGHBORHOOD HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8791 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710104476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 POPLAR ST",
"city": "ROSLINDALE",
"state": "MA",
"postal_code": "021312505",
"telephone_number": "617-323-8013",
"fax_number": "617-323-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 POPLAR ST",
"city": "ROSLINDALE",
"state": "MA",
"postal_code": "021312505",
"telephone_number": "617-323-8013",
"fax_number": "617-323-8014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULAKOS",
"first_name": "DIMITRIOS",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "8791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0311847",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC&BS",
"identifier": "Y67509",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "37992",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "409838",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH",
"identifier": "0022742",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roslindale, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.