Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary Elise Waller, PT, DPT

Individual provider Orthopedic Physical Therapist · NPI 1649865692

Mary Elise Waller, PT, DPT is an Orthopedic Physical Therapist in Southlake, Texas. Licensed in Texas. Registered with an NPI since 2021.

Licensed in
TX
In the registry since
2021
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2419 W Southlake Blvd Ste 100
Southlake, TX 76092-1506
Phone: (469) 535-6842
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X · Licence 1342742 (TX)

Record details

NPI number1649865692
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedMarch 2, 2021
Last updated in NPPESMarch 2, 2021
Certification dateMarch 2, 2021

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