Individual
MR. LARRY MENDOZA LACANIENTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2055 HERITAGE DR, MARTINSVILLE, IN 46151-3158
(765) 342-3305
(765) 342-9575
Mailing address
3827 S BUSHMILL DR, BLOOMINGTON, IN 47403-8943
(812) 345-4643
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002937A
IN
Other
Enumeration date
12/17/2009
Last updated
12/17/2009
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