MEDICARE: SUMMER MORGAN FIDLOW LMT

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	225700000X	Massage Therapist	MSG016536	PA

General Provider Information

NPI Number	:	1205790490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER MORGAN FIDLOW LMT

Provider Business Mailing Address
First Line	:	18 S 9TH ST STE 104D
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1630
Country	:	US
Telephone Number	:	570-664-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 S 9TH ST STE 104D
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1630
Country	:	US
Telephone Number	:	570-664-0702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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