Healthcare Provider Details

I. General information

NPI: 1205790490
Provider Name (Legal Business Name): SUMMER MORGAN FIDLOW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S 9TH ST STE 104D
STROUDSBURG PA
18360-1630
US

IV. Provider business mailing address

18 S 9TH ST STE 104D
STROUDSBURG PA
18360-1630
US

V. Phone/Fax

Practice location:
  • Phone: 570-664-0702
  • Fax:
Mailing address:
  • Phone: 570-664-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG016536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: