Healthcare Provider Details

I. General information

NPI: 1811828726
Provider Name (Legal Business Name): MICHAELA CANNISTRACI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W 11TH ST STE 119
TRACY CA
95376-3860
US

IV. Provider business mailing address

311 RAY ST
PLEASANTON CA
94566-6621
US

V. Phone/Fax

Practice location:
  • Phone: 209-237-2484
  • Fax: 209-362-4875
Mailing address:
  • Phone: 925-399-5796
  • Fax: 209-362-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: