Marisa Petrone Gough, PT
NPI 1871840645ActiveIndividual· Physical Therapist· Wayne, NJ
Physical Therapist (PT) in Wayne, New Jersey, trained at Rutgers School of Dental Medicine (class of 2012). Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1871840645 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT |
| Sole proprietor | Yes |
| NPI issued | Aug 10, 2012 |
| Last updated in NPPES | Jun 4, 2026 |
| Certified by provider | Jun 4, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 40QA01450400 | NJ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (NJ) |
|---|
Education and affiliations
| Medical school | Rutgers School of Dental Medicine |
|---|---|
| Graduation year | 2012 |
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Jag-One Physical Therapy LLCJersey City, NJ · 340 clinicians
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All 127 physical therapists in Wayne · All physical therapists in New Jersey