MARK WALLER PT
NPI 1801525381
Physical Therapist in Lehigh Acres, FL

Active since June 09, 2022
11742 EROS RD, LEHIGH ACRES, FL 33971(239) 671-8962 Get Directions Write a Review

NPPES record last updated: June 9, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mark Waller Pt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK WALLER PT (NPI 1801525381) is an individual physical therapist in Lehigh Acres, Florida, licensed in Florida (16250) and active in the NPI registry since June 2022.

NPPES Registry Identity

NPI1801525381
Entity TypeIndividualMale
Primary Taxonomy225100000X
Provider Legal NameMARK WALLERCredential: PT
Location Address11742 EROS RDLehigh Acres, FL 33971-3759
Mailing Address11742 Eros RdLehigh Acres, FL 33971-3759 · (239) 671-8962
Sole ProprietorNo
Enumeration DateJune 9, 2022
NPPES CertifiedJune 9, 2022
✔ NPI 1801525381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
License✔ Licensed in FL · 16250
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
11742 EROS RD, Lehigh Acres, FL 33971

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mark Waller Pt is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Mark Waller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Physical Therapist
17470 BROOKSIDE TRACE CT
Tampa, FL 33647
  • Reassigned Medicare billing, Florida enrollment
  • 264 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Waller's NPI number?

The NPI number for Mark Waller is 1801525381. It was assigned to this individual provider in the NPPES registry on June 9, 2022.

Where is Mark Waller located?

Mark Waller practices at 11742 Eros Rd, Lehigh Acres, FL 33971. The listed phone number is (239) 671-8962.

What is Mark Waller's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Mark Waller enrolled in Medicare?

Yes. Mark Waller is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mark Waller's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mark Waller reassigns Medicare benefits to Legacy Healthcare Services, Inc (Tampa, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mark Waller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mark Waller was last updated on June 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.