Jonathan Gogolakis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13666 Issued in MN

Practice address

9505 Blackoaks LN N
Maple Grove, MN 55311-1229

Phone

(763) 420-4111

NPI assigned

Sep 9, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Minnesota Medical School, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Odom Sports Medicine, P.a.

  • Sports Medicine (Family Medicine) Physician
  • Eden Prairie, MN
  • NPI 1275557886
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1770319675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 W 36TH ST STE 100",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 BLACKOAKS LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111229",
            "telephone_number": "763-420-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOGOLAKIS",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "13666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiara L Godfrey
• Jill Marie Goeman
• Samantha Goettsche
• Bonnie Goff, RN
• Gogo Home Care LLC
• Golden Homecare Services LLC
• Julie Ann Gomer, DBH
• Gopher (Maple Grove) TRS LLC
• Zeleke Belay Goshu, RPH
• Christine Suzanne Goudge Walker, MD

• Physical Therapist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.