Provider Demographics
NPI:1659263903
Name:KRYZAK, JASON ZACHARY (LMT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ZACHARY
Last Name:KRYZAK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5150
Mailing Address - Country:US
Mailing Address - Phone:541-291-3282
Mailing Address - Fax:
Practice Address - Street 1:315 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3002
Practice Address - Country:US
Practice Address - Phone:541-291-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist