Healthcare Provider Details

I. General information

NPI: 1861543522
Provider Name (Legal Business Name): AWC PT & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96-98 MILLBURN AVENUE SUITE #102
MILLBURN NJ
07041-1944
US

IV. Provider business mailing address

96-98 MILLBURN AVENUE SUITE #102
MILLBURN NJ
07041-1944
US

V. Phone/Fax

Practice location:
  • Phone: 973-486-0212
  • Fax: 973-486-0212
Mailing address:
  • Phone: 973-486-0212
  • Fax: 973-486-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00567300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00459400
License Number StateNJ

VIII. Authorized Official

Name: DR. DANIEL HOUSHMAND
Title or Position: OWNER
Credential: D.C., D.I.B.E.
Phone: 973-486-0212