MEDICARE: MARISA PETRONE GOUGH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01450400	NJ

General Provider Information

NPI Number	:	1871840645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA PETRONE GOUGH PT

Provider Business Mailing Address
First Line	:	450 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8480
Country	:	US
Telephone Number	:	973-706-7620
Fax Number	:	973-706-7619

Provider Business Practice Location Address
First Line	:	450 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8480
Country	:	US
Telephone Number	:	973-706-7620
Fax Number	:	973-706-7619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	06/04/2026

Similar Medicare Providers

1619061710 — DR. GARY STEVEN STRUBLE PT
Practice Location Address:

450 HAMBURG TPKE
WAYNE, NJ
07470-8480

Practice Phone: 973-706-7620
Practice Fax:

1174667646 — DR. CARRIE LYNNE JONES PT, DPT, OCS
Practice Location Address:

450 HAMBURG TPKE
WAYNE, NJ
07470-8480

Practice Phone: 973-706-7620
Practice Fax: 973-706-7619

1487810081 — DR. DAVID LEE GOLDBLOOM M.D.
Practice Location Address:

450 HAMBURG TPKE , SUITE 2F
WAYNE, NJ
07470-8480

Practice Phone: 973-617-6352
Practice Fax: 917-677-5012

1730319294 — MRS. JOLANTA SZMUC LPC
Practice Location Address:

450 HAMBURG TPKE , SUITE 2B
WAYNE, NJ
07470-8480

Practice Phone: 973-800-7123
Practice Fax: 973-521-8561

1114250057 — WAYNE ORTHOPEDIC PHYSICAL THERAPY, PC
Practice Location Address:

450 HAMBURG TPKE
WAYNE, NJ
07470-8480

Practice Phone: 973-934-8150
Practice Fax:

1831524669 — DR. CATHERINE ANDRASKO DPT
Practice Location Address:

450 HAMBURG TPKE
WAYNE, NJ
07470-8480

Practice Phone: 973-706-7620
Practice Fax:

Directions to “ MARISA PETRONE GOUGH PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.