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General NPI Number Information
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NPI Number | 1114568359
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Entity Type | Individual
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Provider Name | THOMAS TYDLACKA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 21216 NORTHWEST FWY STE 620
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City | CYPRESS
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State | TX
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Zip | 77429-4699
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Country | US
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Telephone | 281-807-4380
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Fax | 833-521-2189
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Provider Business Mailing Address
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Address Line | 3023 MARINA BAY DR STE 105
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2882
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Country | US
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Telephone | 713-943-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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