Agnes Leonia Van De Put, PT in Sebastopol, CA - Medicare Physical Therapist Provider

Agnes Leonia Van De Put, PT is a medicare enrolled "Physical Therapist" provider in Sebastopol, California. Her current practice location is 6914 Sebastopol Ave, Sebastopol, California. You can reach out to her office (for appointments etc.) via phone at (707) 327-0998.

Agnes Leonia Van De Put is licensed to practice in California (license number 25323) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1588812721.

Contact Information

	Agnes Leonia Van De Put, PT
	6914 Sebastopol Ave, Sebastopol, CA 95472-3459
	(707) 327-0998
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Agnes Leonia Van De Put
Gender	Female
Speciality	Physical Therapist
Location	6914 Sebastopol Ave, Sebastopol, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1588812721
Provider Enumeration Date: 08/29/2008
Last Update Date: 09/06/2023

Medicare PECOS Information:

PECOS PAC ID: 9234292699
Enrollment ID: I20211026001256

Medical Identifiers

Medical identifiers for Agnes Leonia Van De Put such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1588812721	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	2160 (Hawaii)	Secondary
225100000X	Physical Therapist	25323 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Agnes Leonia Van De Put allows following entities to bill medicare on her behalf.

Provider Name	Patricia D Martinez
Provider Type	Practitioner - Physical Therapist In Private Practice
Provider Identifiers	NPI Number: 1326180175 PECOS PAC ID: 2264325927 Enrollment ID: I20040209001298

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Agnes Leonia Van De Put is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Agnes Leonia Van De Put, PT 7809 Stefenoni Ct Unit A, Sebastopol, CA 95472-3536 Ph: (808) 937-3943	Agnes Leonia Van De Put, PT 6914 Sebastopol Ave, Sebastopol, CA 95472-3459 Ph: (707) 327-0998

Reviews and Comments

Physical Therapist in Sebastopol, CA

Paula Tanksley, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 130 Petaluma Ave, Ste 2-g, Sebastopol, CA 95472 Phone: 707-888-5093 Fax: 707-222-6572
Teresa L Burk, P.T. Physical Therapist Medicare: Medicare Enrolled Practice Location: 100 Pleasant Hill Ave N, Sebastopol, CA 95472 Phone: 707-829-3282
Kathy Mcconnell, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 100 Pleasant Hill Ave N, Sebastopol, CA 95472 Phone: 707-829-3282 Fax: 707-829-3287
Mrs. Samantha Marie Jacobs, M.S.P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 100 Pleasant Hill Ave N, Sebastopol, CA 95472 Phone: 707-829-3282 Fax: 707-829-3287
Elyse Detweiler Mccluskey, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 100 Pleasant Hill Ave N, Sebastopol, CA 95472 Phone: 707-829-3282 Fax: 707-829-3287
Patricia Donovan Martinez, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 100 Pleasant Hill Ave N, Sebastopol, CA 95472 Phone: 707-829-3282 Fax: 707-829-3287
Ms. Julie Clare Smith, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 500 Swain Ave, Sebastopol, CA 95472 Phone: 707-829-1250

Agnes Leonia Van De Put, PT - Medicare Physical Therapist in Sebastopol, CA