Individual
MARY ELISE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2419 W SOUTHLAKE BLVD STE 100, SOUTHLAKE, TX 76092-1506
(469) 535-6842
Mailing address
5828 COLHURST ST, DALLAS, TX 75230-5020
(214) 926-6041
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1342742
TX
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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