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.
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.
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.
Use this form to submit completion documents demonstrating compliance with the rules for Dry Needling training and education.
If you wish to inactivate your AZ license or certificate, complete this form and upload to an inactivation service request through your eLicensing portal.
Complete this form if you are not licensed or certified in Arizona but seek to provide telehealth services in Arizona pursuant to A.R.S. § 36-3606.
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]
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Not Practicing.
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Retired.
Please complete the forms and upload the appropriate documents into the eLicensing System.
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.
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.