# ELMWOOD ORTHOPEDIC REHAB CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265567077
- **Authorized official:** IGOR YATSKAR M.S., P.T. (PRESIDENT)
- **Authorized official phone:** (617) 442-3462

## Contact information

- **Practice address:** 120 DUDLEY ST STE 201, PROVIDENCE, RI 02905-2431
- **Practice address phone:** (401) 941-1347
- **Practice address fax:** (617) 445-7874
- **Mailing address:** 193 ELMWOOD AVE, PROVIDENCE, RI 02907-1460
- **Mailing address phone:** (401) 459-4000
- **Mailing address fax:** (401) 459-4005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT01849 | RI | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 01/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | E061618 | — | RI |