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Contact Information Change and Verification Requests

 
Change Contact Information
 
You may now update your contact information online! Click the orange button above to get started.

Credential holders shall notify the board within 30 days of any change in home address, phone number, email address, or physical therapy worksites. 
 
 Change of Address Form (PDF-90KB)-- You may change your address and contact information online using the orange button above, or the form may be mailed or faxed to our office, or you may email the changes to kybpt@ky.gov 

For name changes, mail or fax a copy of the legal document authorizing the change to the board office (201 KAR 22:035).
 
Should you wish to obtain a new wallet card or wall certificate, mail a check to our agency with your request.  Duplicate wallet cards - $15; Wall certificates - $25.
 
Verification Request (PDF-16KB) Do you need to verify your KY PT/PTA credential to another state licensing board? Please submit a signed request to the board office along with the fee of $20.00 for each verification. 
 
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