Individual
AGNES LEONIA VAN DE PUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6914 SEBASTOPOL AVE, SEBASTOPOL, CA 95472-3459
(707) 327-0998
Mailing address
7809 STEFENONI CT UNIT A, SEBASTOPOL, CA 95472-3536
(808) 937-3943
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2160
HI
225100000X
Physical Therapist
Primary
25323
CA
Other
Enumeration date
08/29/2008
Last updated
09/06/2023
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