Individual provider Active NPI

Kirbie Conner, DPT

  • Physical Therapist
  • Roanoke, VA
National Provider Identifier
1306651864
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305217483 Issued in VA
Practice address
2033 Colonial Ave SW SPC 138
Roanoke, VA 24015-3210
Phone
(540) 466-3981
Fax
(540) 739-7476
NPI assigned
Feb 11, 2025
Last updated
Nov 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305217483 VA Primary

Addresses

Primary practice location

2033 Colonial Ave SW SPC 138
Roanoke, VA 24015-3210

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260107000418 VA Practitioner - Physical Therapist in Private Practice 4789170051 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physical Therapy LLCGroup PAC ID 6406759281, 225 clinicians

Practice addresses (Care Compare)

2033 Colonial Ave SW
Suite 138
Roanoke, VA 24015-3210
Phone (540) 466-3981

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305217483VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Sportscare & Rehab, LLC Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients
Athletico, LTD Physical Therapist CurrentSince Nov 5, 2025 Accepting new patients
Professional Sportscare & Rehab, LLC Physical Therapist Past Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

11662 Sudley Manor Dr
#50B
Manassas, VA 20109
Phone (571) 321-5720

2033 Colonial Ave SW
Ste 138
Roanoke, VA 24015
Phone (540) 466-3981

4625 Virginia Beach Blvd
Ste 103
Virginia Beach, VA 23462
Phone (757) 600-5999

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762473600000",
    "number": "1306651864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 COLONIAL AVE SW SPC 138",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153210",
            "telephone_number": "540-466-3981",
            "fax_number": "540-739-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "KIRBIE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-11",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305217483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.