MEDICARE: ISHA RECOVERY AND SCULPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1821809765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISHA RECOVERY AND SCULPT

Provider Business Mailing Address
First Line	:	1770 E FT UNION BLVD STE 101
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2881
Country	:	US
Telephone Number	:	385-275-5765
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 E FT UNION BLVD STE 101
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2881
Country	:	US
Telephone Number	:	385-275-5765
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TENISHA HICKS
Credential	:	CMA
Telephone Number	:	385-275-5765

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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Directions to “ISHA RECOVERY AND SCULPT ” Practice Location

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