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Licensees & Certificate Holders
Havasu Falls

Service Requests

A license verification is an official form verifying license/certificate details & discipline history sent directly from the AZ PT Board to another licensing or verifying entity.

Fee: $15

To request a license/certificate verification:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select License Verification as the Service Request Type
  3. Supply recipient details in the Description block. Include mailing address and/or email address of recipient
  4. You may upload additional forms for informational purposes but know that the AZ PT Board will send our own verification template
  5. Pay for and Submit your service request

When your service request is processed you'll be notified via email and provided a copy of your verification form.

Used to update mailing and/or public address. Requires a 2 step process outlined in the instructions below. Note: AZ PT Board requires BOTH a mailing and a public address associated with your license/certificate.

Fee: $0

To request an address change:
Follow these instructions completely to ensure your address is updated AND linked to your license/certificate.

  1. Log into eLicense.az.gov
  2. View your profile and ensure your desired mailing and public addresses are included in your list of addresses. Add as necessary
  3. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, and select Self-Service Address Change as the Service Request Type
  4. The 2nd screen of the Self-Service Address Change will prompt you to specify (from your list of addresses) a Mailing and a Public address (note, Board requires you supply both categories of address)
  5. Follow any other screen prompts to complete and submit the Self-Service Address Change

If the detailed steps above are properly completed in their entirety, your address changes will become immediately effective.

Email address update requests must be submitted to staff. Supply your name, license/certificate number and request to staff via email. Staff contact information is available using the "About" menu.

A copy of your license/certificate suitable for framing and/or displaying on a wall. Does not indicate expiration date.

Fee: $10

To request a duplicate license/certificate:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select Duplicate Certificate as the Service Request Type
  3. Pay for and Submit your service request
  4. The duplicate license/certificate will be mailed to your mailing address of record so ensure it is correct.

When your service request is processed you'll be notified via email.

A copy of your wallet card. Includes current expiration date.

Fee: $0

To request a duplicate wallet card:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select Duplicate Wallet Card as the Service Request Type
  3. Submit your service request
  4. The duplicate wallet card will be mailed to your mailing address of record so ensure it is correct.

When your service request is processed you'll be notified via email.

Used to update a legally changed name. Service request requires supplemental documentation as outlined in the instructions below.

Fee: $0

To request a name change:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select Name Change as the Service Request Type
  3. Upload required legal documentation such as: Divorce decree (including seal and judicial signature); Marriage license / certificate; Court order (certified)
  4. Upload supporting documentation displaying your changed name: US Government Issued Identification
  5. Submit your service request

When your service request is processed you'll be notified via email.

Used to change status to Inactive / Not Practicing and requires uploaded forms. Indicates licensee/certificate holder is not currently working in AZ. Maintaining an Inactive / Not Practicing license/certificate requires renewal on same schedule as active licenses. Click here for more details. 

Fee: $0

To inactivate a license/certificate:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select Request to Inactivate License as the Service Request Type
  3. Complete the inactivation form in its entirety and upload to your service request
  4. Submit your service request
  5. Await email confirmation that your service request has been processed and your license/certificate has been updated to Inactive / Not Practicing
  6. CAVEAT: To maintain an Inactive / Not Practicing status, your license/certificate MUST be renewed on the same schedule as an active license/certificate. Failure to do so will result in a status update (post expiration) to Inactive / Administrative Suspension

When your service request is processed you'll be notified via email.

Used to change status to Inactive / Retired and requires uploaded forms. Indicates licensee/certificate holder is no longer working as a PT/PTA in AZ or elsewhere. Maintaining an Inactive / Retired license/certificate requires renewal on same schedule as active licenses. Click here for more details. 

Fee: $0

To retire a license/certificate:

  1. Log into eLicense.az.gov
  2. Use the Service Request Menu and select the Physical Therapy Board, select your license/certificate, select Request to Retire as the Service Request Type
  3. Complete the retirement form in its entirety and upload to your service request
  4. Submit your service request
  5. Await email confirmation that your service request has been processed and your license/certificate has been updated to Inactive / Retired
  6. CAVEAT: To maintain an Inactive / Retired status, your license/certificate MUST be renewed on the same schedule as an active license/certificate. Failure to do so will result in a status update (post expiration) to Inactive / Administrative Suspension

When your service request is processed you'll be notified via email.

(Laws) Arizona Revised Statutes; Title 32 Chapter 19 (Revised 6-1-19)

Applications
New Applicant
Other Applicant
Physical Therapist
Business Entity
Supervision
Physical Therapist Assistants
Foreign Educated
Continuing Competence
Licensing
Statutes and Rules

Arizona Revised Statutes Title 32 Chapter 19 is specific to the Board of Physical Therapy. This document serves as part of the AZLAW Jurisprudence Exam study materials; commonly referred to as AZLAW Statutes.

(Rules) Arizona Administrative Code TITLE 4 Chapter 24

Applications
New Applicant
Other Applicant
Physical Therapist
Business Entity
Supervision
Physical Therapist Assistants
Foreign Educated
Continuing Competence
Licensing
Statutes and Rules

Arizona Administrative Code Title 4 Chapter 24 is specific to the Board of Physical Therapy. This document serves as part of the AZLAW Jurisprudence Exam study materials; commonly referred to as AZLAW Rules.

ADA Accommodations For Testing

Applications
Form
Licensing

This form must be completed by those applicants seeking ADA Accommodations for the NPTE and/or AZLAW exams. Upload the completed form to your application and submit via the eLicensing system.

Arizona Statement of Citizenship and Alien Status Form

Applications
New Applicant
Other Applicant
Form
Licensing

This form must be completed in its entirety by every applicant for PT licensure or PTA certification. Upload the completed form to your application through the eLicensing system.

AZLAW Exam Handbook

Applications
New Applicant
Other Applicant
Physical Therapist
Physical Therapist Assistants
Foreign Educated

This handbook is the road map to the AZLAW Jurisprudence Exam. Use this handbook in conjunction with the Arizona Revised Statutes (Laws) and Arizona Administrative Code (Rules) as your study materials for the AZLAW exam.

Continuing Competence Audit Form

Continuing Competence
Form
Licensing

Licensees and certificate holders may use this form to independently track their own continuing competence activities. If audited, this form is to be downloaded and submitted electronically, with all associated continuing competence certificates of completion, to the Board office. Licensees and certificate holders selected for continuing competence audit will be noticed via certified mail.

Dry Needling - Frequently Asked Questions

Other Applicant
Physical Therapist
Physical Therapist Assistants
Licensing

Review these document to learn how to comply with the rules for training and education standards related to dry needling, which are effective July 1, 2015.

Dry Needling Training Submission Form

Other Applicant
Physical Therapist
Physical Therapist Assistants
Form
Licensing

Use this form to submit completion documents demonstrating compliance with the rules for Dry Needling training and education.

Inactivate a PT License or PTA Certificate

Other Applicant
Physical Therapist
Physical Therapist Assistants
Form
Licensing

If you wish to inactivate your AZ license or certificate, complete this form and upload to an inactivation service request through your eLicensing portal. 

PT Compact

Other Applicant
Public
Consumer
Licensing
Links

Public Records/Directory Request Form

Public
Consumer
Form
Licensing

Complete this form to request copies of records, including a Directory of Arizona Licensed Physical Therapists and/or Physical Therapist Assistants. Fees are charged for copies of certain records. Mail completed form and payment to the Board's office as indicated on the form. Credit card payments are not accepted for Public Records requests.

A person may obtain additional public records related to any licensee or certificate holder, including dismissed complaints and non-disciplinary actions and orders, by contacting the board directly.

Contact Monica Crowley at [email protected]

Required Reinstatement Documents

Other Applicant
Form
Licensing

Please complete the forms and upload the appropriate documents into the eLicensing System.

Retire a PT License or PTA Certificate

Other Applicant
Physical Therapist
Physical Therapist Assistants
Form
Licensing

If you wish to retire your AZ license or certificate, complete this form and upload to a "retire" service request through your eLicensing portal. NOTE, retiring a license/certificate indicates you are no longer working as a PT/PTA in AZ or elsewhere.

Third Party Verification

Public
Consumer
Form
Licensing

DO NOT USE this form if you have ever been a licensed PT or certified PTA in Arizona.  Previous or current AZ licensed PTs and certified PTAs must log into eLicensing to submit a Service Request for a license verification to be sent to another licensing board. If you have trouble logging into eLicensing contact staff. 

USE THIS FORM ONLY if you are a 3rd Party entity requesting verification of an Arizona licensed PT or certified PTA. Complete this form and submit with payment to request an official verification of licensure to be sent to another licensing board or college/university.