Healthcare Provider Details

I. General information

NPI: 1568280469
Provider Name (Legal Business Name): MIGHTY MASTERS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 MAIN ST
BELMAR NJ
07719-2715
US

IV. Provider business mailing address

1314 MAIN ST
BELMAR NJ
07719-2715
US

V. Phone/Fax

Practice location:
  • Phone: 732-664-4085
  • Fax:
Mailing address:
  • Phone: 848-404-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMY DIPASQUALE
Title or Position: OWNER
Credential:
Phone: 732-664-4085