{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ISMATA CORP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7018 HAWAII KAI DR",
"SecondLineMailingAddress": "504",
"MailingAddressCityName": "HONOLULU",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96825-4150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-779-8475",
"MailingAddressFaxNumber": "808-394-8702",
"FirstLinePracticeLocationAddress": "130 KAILUA RD",
"SecondLinePracticeLocationAddress": "107",
"PracticeLocationAddressCityName": "KAILUA",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96734-3420",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-779-8475",
"PracticeLocationAddressFaxNumber": "808-394-8702",
"EnumerationDate": "06/11/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARRIS",
"AuthorizedOfficialFirstName": "SHEILA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "808-779-8475",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT1965",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}