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General NPI Number Information
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NPI Number | 1780063768
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Entity Type | Individual
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Provider Name | MARISA GOPAUL
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Gender | Female
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Dates
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Enumeration Date | 05/25/2015
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 104 W D. L. INGRAM AVENUE BLDG. 1408 CANNON AFB
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City | CANNON AFB
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-784-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 SW 46TH CT APT 1001
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City | OCALA
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State | FL
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Zip | 34474-6271
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Country | US
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Telephone | 352-433-1918
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Fax | 352-433-0950
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT30177
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License Number State | FL
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