Licensees & Certificate Holders
01 Address & Telephone # Change Form
Complete and submit this form to the Board office to change address and telephone information on record with the Arizona State Board of Physical Therapy.
| Attachment | Size |
|---|---|
 changeofaddress12042015.pdf | 60.1 KB |
02 Request for Verification
Download this form to request the board office prepare an official verification of licensure document to be forwarded to another licensing board or college / university.
| Attachment | Size |
|---|---|
| Download | 132.53 KB |
03 Request Form for Duplicate License & Wallet Card
Download this form to request the board office prepare a duplicate wall license/certificate and wallet card.
| Attachment | Size |
|---|---|
| Download | 226.23 KB |
04 Name Change Form
Complete and submit this form to the Board office to file a name change with the Arizona State Board of Physical Therapy.
| Attachment | Size |
|---|---|
| Download | 137.43 KB |
05 ARIZONA STATEMENT OF CITIZENSHIP AND ALIEN STATUS FOR STATE PUBLIC BENEFITS
Use this form if you are required to provide proof of your current lawful ability to work in the United States and recieve public bennefits, which include a professional license.
| Attachment | Size |
|---|---|
| Download | 45.3 KB |
06 PROFESSIONAL STANDARDS OF TRAINING AND EDUCATION; DRY NEEDLING
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.
| Attachment | Size |
|---|---|
| Frequently Asked Questions | 128.56 KB |
| Education and Training Submission Cover Sheet; Dry Needling | 82.52 KB |
