Healthcare Provider Details

I. General information

NPI: 1306757281
Provider Name (Legal Business Name): SOMA VITA THERAPEUTIC WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 TUMBLEWATER BLVD
OCOEE FL
34761-3349
US

IV. Provider business mailing address

1934 TUMBLEWATER BLVD
OCOEE FL
34761-3349
US

V. Phone/Fax

Practice location:
  • Phone: 407-766-0616
  • Fax:
Mailing address:
  • Phone: 407-766-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEVIKA JIBODH
Title or Position: OWNER / MANAGING MEMBER
Credential: OTA
Phone: 407-766-0616