Provider Demographics
NPI:1538835244
Name:MORIN, ELIJAH AXEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:AXEL
Last Name:MORIN
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 1:2210 RIVER RUN DR UNIT 64
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5812
Mailing Address - Country:US
Mailing Address - Phone:732-407-8651
Mailing Address - Fax:
Practice Address - Street 1:7425 MISSION VALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4409
Practice Address - Country:US
Practice Address - Phone:619-219-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist