Healthcare Provider Details

I. General information

NPI: 1740105097
Provider Name (Legal Business Name): THERESA M SHOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 GEORGIAN PL
SOMERSET PA
15501-1610
US

IV. Provider business mailing address

209 GEORGIAN PL
SOMERSET PA
15501-1610
US

V. Phone/Fax

Practice location:
  • Phone: 814-445-6440
  • Fax: 814-443-3242
Mailing address:
  • Phone: 814-445-6440
  • Fax: 814-443-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG000318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: