Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Agnes Leonia Van de Put, PT

Individual provider Physical Therapist · NPI 1588812721

Agnes Leonia Van de Put, PT is a Physical Therapist in Private Practice in Sebastopol, California. Qualified in 2018, 8 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in California and Hawaii.

Years since qualifying
8
Licensed in
CA, HI
In the registry since
2008
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

6914 Sebastopol Ave
Sebastopol, CA 95472-3459
Phone: (707) 327-0998
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 25323 (CA)
Physical Therapist Taxonomy 225100000X · Licence 2160 (HI)

Record details

NPI number1588812721
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorYes
NPI enumeratedAugust 29, 2008
Last updated in NPPESSeptember 6, 2023
Certification dateSeptember 6, 2023
Mailing address7809 Stefenoni Ct Unit A, Sebastopol, CA 95472-3536

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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