| Doctor Name: | MR. LARRY MENDOZA LACANIENTA |
| NPI Number: | 1952630162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 05002937A |
| Business Practice Address: | 2055 Heritage Dr Martinsville, IN - 461513158 |
| Business Phone Number: | 7653423305 |
| Business Fax Number: | 7653429575 |
| Mailing Address: | 3827 S Bushmill Dr, BLOOMINGTON |
| State: | IN |
| Postal Code: | 474038943 |
| Phone Number: | 8123454643 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2009 |
| NPI Last Update Date: | 12/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05002937A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |