Active NPI
Konner Sloane Street, DPT
- Physical Therapist
- Maryville, IL
National Provider Identifier
1780453308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.029219
- Practice address
- 6800 State Route 162
Maryville, IL 62062 - Phone
- (618) 288-5711
- NPI assigned
- Dec 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 008995 | KY | |
| Pediatric Physical Therapist | 2251P0200X | 008995 | KY | |
| Physical Therapist | 225100000X | 070.029219 | IL | Primary |
Addresses
Primary practice location
6800 State Route 162
Maryville, IL 62062
Mailing address
6800 State Route 162
Maryville, IL 62062-8500
Phone (618) 288-5711
Other practice location 1
71 Orphanage Rd
Ft Mitchell, KY 41017-3006
Phone (859) 331-0880 ext. 249
Other names 1
- Konner Sloane Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240828005192 | KY | Practitioner - Physical Therapist in Private Practice | 6507305943 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.029219 | IL | MD | Physical Therapist |
| 008995 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756252800000",
"number": "1780453308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6800 STATE ROUTE 162",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620628500",
"telephone_number": "618-288-5711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6800 STATE ROUTE 162",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "62062",
"telephone_number": "618-288-5711"
}
],
"practiceLocations": [
{
"address_1": "71 Orphanage Rd",
"address_purpose": "LOCATION",
"city": "Ft Mitchell",
"state": "KY",
"postal_code": "410173006",
"country_code": "US",
"telephone_number": "859-331-0880 x249",
"fax_number": "855-719-0501",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STREET",
"first_name": "KONNER",
"middle_name": "SLOANE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-22",
"last_updated": "2025-08-27",
"certification_date": "2025-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KY",
"license": "008995",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "KY",
"license": "008995",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.029219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KONNER",
"last_name": "SMITH",
"middle_name": "SLOANE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.