Provider Demographics
NPI:1073197828
Name:SIGNATURE FITNESS
Entity Type:Organization
Organization Name:SIGNATURE FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-820-0151
Mailing Address - Street 1:1609 N STRONG BLVD STE 500A
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3839
Mailing Address - Country:US
Mailing Address - Phone:918-715-3114
Mailing Address - Fax:918-715-3114
Practice Address - Street 1:1609 N STRONG BLVD STE 500A
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-3839
Practice Address - Country:US
Practice Address - Phone:918-715-3114
Practice Address - Fax:918-715-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty