NPI age
5 years
Enumerated 2021-03-02
● Active
Type 1 · Individual
Mary Elise Waller, PT, DPT
Waller is 1 of 4 physical therapist providers in Southlake and 1 of 757 in Texas.
Primary specialty
Physical Therapist
Licensed in
TX
1 state
Status
Active
No deactivations on record
Last NPPES update
2021-03-02
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 757 active physical therapist providers in Texas.
NPI age
5 years
↓ 5 yr below median (10 yr)
State licenses
1 state
8% of peers hold multiple states
Subspecialties
0
23% of peers hold subspecialties
NPI lifetime · 2021 → 2026
2021-03Enumerated in NPPES
2021
2026
Where they practice
Practice location
2419 W Southlake Blvd Ste 100
Southlake, TX 760921506
Mailing address
5828 Colhurst St
Dallas, TX 752305020
Specialties
-
Physical Therapist PrimaryA licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology,...
Practice context
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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Request a quote →How to verify this provider
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.