Provider Demographics
NPI:1114568359
Name:TYDLACKA, THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TYDLACKA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 MARINA BAY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2882
Mailing Address - Country:US
Mailing Address - Phone:713-943-1100
Mailing Address - Fax:
Practice Address - Street 1:21216 NORTHWEST FWY STE 620
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4699
Practice Address - Country:US
Practice Address - Phone:281-807-4380
Practice Address - Fax:833-521-2189
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic