Provider Demographics
NPI:1013719095
Name:WHATLEY, MIKAELA (DPT)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 AUSTIN CIR
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-7336
Mailing Address - Country:US
Mailing Address - Phone:214-404-6553
Mailing Address - Fax:
Practice Address - Street 1:1800 E STATE HIGHWAY 114 STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6529
Practice Address - Country:US
Practice Address - Phone:469-919-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1406636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist