Marisa Petrone Gough, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01450400 Issued in NJ

Practice address

450 Hamburg Tpke
Wayne, NJ 07470-8480

Phone

(973) 706-7620

Fax

(973) 706-7619

NPI assigned

Aug 10, 2012

Sex

Female

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 NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Rutgers School of Dental Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jag-One Physical Therapy LLCGroup PAC ID 2769584325, 334 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jag-One Physical Therapy, LLC

  • Physical Therapist
  • West Orange, NJ
  • NPI 1518017144
  Medicare reassignment Care Compare group
• The New Jersey Center of Physical Therapy, PC

  • Physical Therapist
  • Riverdale, NJ
  • NPI 1063508174
  NPD (past)
• Wayne Foot and Ankle Center,PA

  • Foot & Ankle Surgery Podiatrist
  • Wayne, NJ
  • NPI 1669519047
  NPD (past)
• Wayne Orthopedic Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • Wayne, NJ
  • NPI 1114250057

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1871840645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 HAMBURG TPKE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074708480",
            "telephone_number": "973-706-7620",
            "fax_number": "973-706-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 HAMBURG TPKE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074708480",
            "telephone_number": "973-706-7620",
            "fax_number": "973-706-7619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "MARISA",
        "middle_name": "PETRONE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-10",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01450400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Lee Goldbloom, M.D.
• Stephen Andrew Gollance, MD
• Lekha Gopal, M.D.
• Yevgeniy Gordon, DPT
• Kenneth N Gorski, DMD
• Grace Recovery Center
• Gillian Grahame
• Adam Grand, DC
• Nicole Graziano
• Vincent Angelo Graziano, M.D.

• Physical Therapist in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; 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.