Agnes Leonia Van De Put, PT
NPI #1588812721 in Sebastopol, California
Provider Information
- NPI Number
- 1588812721
- Entity Type
- Individual
- Name
- Agnes Leonia Van De Put, PT
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physical Therapist
- Credential
- PT
- Enumeration Date
- Aug 29, 2008
- Last Updated
- Sep 6, 2023
Practice Location
- Address
- 6914 SEBASTOPOL AVE
- City
- Sebastopol
- State
- California
- ZIP Code
- 95472-3459
- Phone
- (707) 327-0998
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapist |
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