Click on the links below for actual forms or additional information.
Change Notification Form (PDF-124KB)
Complete this form and mail or fax to Board office for change of address (home or worksite). Name changes require a copy of the legal document authorizing the change. Your records will be changed in-house only. If you wish to purchase a new wallet card or wall certificate, send your payment as indicated below.
Wallet Cards - $10.00 - Send $10 payable to KY Board of Physical Therapy with your request to Board office.
Wall Certificates -$20.00 - Send $20 payable to KY Board of Physical Therapy with your request to Board office.
Licensure Lists or Labels To order PT/PTA Licensure Lists or mailing labels.
Verification Request (PDF-82KB) Do you need to verify your KY PT/PTA credential to another agency? Submit a signed request to the board office along with the fee of $15 for each verification.
Other State Boards Addresses and telephone numbers of other physical therapy licensing boards.