Provider Demographics
NPI:1689181414
Name:OPTIMAL PERFORMANCE & RECONDITIONING
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE & RECONDITIONING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:240-514-7439
Mailing Address - Street 1:2021 K ST NW STE T125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1011
Mailing Address - Country:US
Mailing Address - Phone:240-514-7439
Mailing Address - Fax:
Practice Address - Street 1:2021 K ST NW STE T125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:240-514-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872086225100000X
VA2305210863225100000X
MD225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty