Mary Elise Waller, PT, DPT
Physical Therapist, Orthopedic in Southlake, TX. Individual provider (NPI-1).
NPI number1649865692
StatusActive
Last updated in NPPESMar 2, 2021
Details
- NPI
- 1649865692
- Entity type
- Individual (NPI-1)
- Name
- Mary Elise Waller
- Credential
- PT, DPT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 2, 2021
- Certification date
- Mar 2, 2021
- Last updated
- Mar 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2251X0800X | Physical Therapist, Orthopedic | 1342742 | TX | Yes |
Practice location
2419 W Southlake Blvd Ste 100Southlake, TX 76092-1506
Phone 469-535-6842
Mailing address
5828 Colhurst StDallas, TX 75230-5020
Phone 214-926-6041
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