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General NPI Number Information
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NPI Number | 1245924919
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Entity Type | Individual
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Provider Name | ABIGAIL MUTCH DPT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1330 QUAIL LAKE LOOP STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4651
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Country | US
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Telephone | 719-579-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 86 WRIGHT RD
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0020185
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 14.014007
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License Number State | CT
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