Mystic Healthcare and Rehabilitation Facility

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

003480 Issued in CT

Legal business name

MYSTIC HEALTHCARE AND REHABILITATION FACILITY

Practice address

475 High St
Mystic, CT 06355-1707

Phone

(860) 536-6070

NPI assigned

Nov 15, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Susan Elizabeth Dorman, RPT

Title

Registered Physical Therapist

Phone

(860) 536-6070

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1174867113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 HIGH ST",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 HIGH ST",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551707",
            "telephone_number": "860-536-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC HEALTHCARE AND REHABILITATION FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "REGISTERED PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "860-536-6070",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "003480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine L. Murray
• Mystic Bridge to Wellness, LLC
• Mystic Dental Group, P.C.
• Mystic Geriatrics, LLC
• Mystic Healthcare & Rehabilitation Center LLC (Mystic Manor)
• Mystic Medical Associates LLC
• Mystic Medical Group, PC
• Mystic River Ambulance Association, Inc
• Mystic Services, LLC (Mystic Bridge to Wellness)
• Mystic Spine & Sport LLC

• Physical Therapy Clinic/Center in Mystic, CT
• Providers in Mystic, CT by specialty
• Physical Therapy Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.