Provider Demographics
NPI:1003065368
Name:RIFFLE, JASON RALPH (CP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RALPH
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 LATROBE DR STE 430
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1361
Mailing Address - Country:US
Mailing Address - Phone:704-375-2587
Mailing Address - Fax:704-333-4429
Practice Address - Street 1:3707 LATROBE DR STE 430
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1361
Practice Address - Country:US
Practice Address - Phone:704-375-2587
Practice Address - Fax:704-333-4429
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3181744P3200X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management