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Nevada State Board of Physical Therapy Examiners - illinois physical therapy license verification
Nevada Physical Therapy Board
3291 North Buffalo Drive, Suite 100 ∙ Las Vegas, NV 89129
Phone (702) 876-5535 ∙ Facsimile (702) 876-2097
In order to provide an official written license verification, the Board requires a formal request signed by the licensee. In that regard, please use this form to request a license verification to another licensing jurisdiction, insurance company, employer, etc.
NAME: ______________________________________________________________________
LICENSE # _________________________
Please mail an official verification of my license to the following:
(Be sure to provide a complete address)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNATURE: __________________________________________________
DATE: ___________________
BOARD OFFICE USE ONLY
← Processed
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REQUEST FOR LICENSE VERIFICATION
Please Type or Print Legibly
Rev. 12/27/2017
How to renew PT license? Complete Education. Complete and submit appropriate application forms, including all required documentation and fee (s). An exam applicant for a permanent license may apply for a temporary license at the same time, but must pay both fees and meet the following conditions: More items...
