Provider Demographics
NPI:1457729071
Name:OCTOPIA
Entity Type:Organization
Organization Name:OCTOPIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:904-562-8571
Mailing Address - Street 1:1304 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3777
Mailing Address - Country:US
Mailing Address - Phone:904-562-8571
Mailing Address - Fax:904-246-4602
Practice Address - Street 1:1304 16TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3777
Practice Address - Country:US
Practice Address - Phone:904-562-8571
Practice Address - Fax:904-246-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-8953251E00000X, 273Y00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No251E00000XAgenciesHome Health
No283X00000XHospitalsRehabilitation Hospital