Provider Demographics
NPI:1679873376
Name:DIDLAKE, DAVID THOMAS (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:DIDLAKE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 OLD 195
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527-4543
Mailing Address - Country:US
Mailing Address - Phone:512-817-8691
Mailing Address - Fax:
Practice Address - Street 1:7780 OLD 195
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:TX
Practice Address - Zip Code:76527-4543
Practice Address - Country:US
Practice Address - Phone:512-817-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1239100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist