Maryland Board of Physical Therapy Examiners

Official State License Verification Request

Please use this form if you are requesting verification of your PT/PTA license for another state.

The fee for the License Verification request is $25 payable at the Online Payment Center (select Licensing and then Verification). The payment receipt must be uploaded to this request form. Request without proof of payment will not be processed.


Please make sure to list the full name and address of the person or organization that should receive your License Verification. If they accept license verifications via email, please list their email address.

 
 
 
 
Phone
 
 

Please enter the full address of the recipient of the the License Verification.


Enter N/A if not applicable.

 

Enter the recipient's email address if License Verification should be sent electronically (fastest method).


Enter N/A if not applicable.

 

The fee for an official License Verification is $25. Please pay the fee at the Online Payment Center (select Licensing and then Verification).

Request without proof of payment will not be processed.

Drop your files here