Provider Demographics
NPI:1649695370
Name:BAJSANSKI, LORI ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:BAJSANSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9984 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1842
Mailing Address - Country:US
Mailing Address - Phone:941-224-6509
Mailing Address - Fax:
Practice Address - Street 1:13005 COMMUNITY CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4000
Practice Address - Country:US
Practice Address - Phone:813-969-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist