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  3. Inactivate A PT Or PTA License

Inactivate a PT or PTA License

If you wish to inactivate your AZ PT or PTA license, complete this form and upload to an inactivation status change request through your Licensee Portal. 

Document Type
Other Applicant
Physical Therapist
Physical Therapist Assistants
Form
Licensing
Inactive Status Request Form_Fillable.pdf
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Arizona State Board of Physical Therapy

1740 W. Adams, Ste. 2450

Phoenix, AZ 85007

Phone: (602) 274-0236

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