MEDICARE: DANIEL RODERER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT022001	OH
2	225100000X	Physical Therapist	CP049120T	VA
3	225100000X	Physical Therapist	CP051648T	SC

General Provider Information

NPI Number	:	1972482693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RODERER PT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 AUGUSTA HWY STE A
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2247
Country	:	US
Telephone Number	:	803-769-3301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	12/16/2025

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Directions to “ DANIEL RODERER PT” Practice Location

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