Healthcare Provider Details

I. General information

NPI: 1912819475
Provider Name (Legal Business Name): JOSHUA JAMES BACANI MARI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 SAN FELIPE RD STE 100
SAN JOSE CA
95135-1546
US

IV. Provider business mailing address

3131 CUNNINGHAM LAKE CT
SAN JOSE CA
95148-1246
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-1552
  • Fax:
Mailing address:
  • Phone: 408-807-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number311003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: