Healthcare Provider Details

I. General information

NPI: 1245924919
Provider Name (Legal Business Name): ABIGAIL MUTCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 MARTIN RD STE 380
FAIRFIELD CA
94534-8610
US

IV. Provider business mailing address

86 WRIGHT RD
COLLINSVILLE CT
06019-3744
US

V. Phone/Fax

Practice location:
  • Phone: 707-437-9001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number309900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: