Provider Demographics
NPI:1821977208
Name:BAJICH, MARY LUCILLE (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LUCILLE
Last Name:BAJICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 S SUMMIT ST APT 2302
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4337
Mailing Address - Country:US
Mailing Address - Phone:913-439-0567
Mailing Address - Fax:
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE A125
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7303
Practice Address - Country:US
Practice Address - Phone:913-676-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist