Daniel E. Bluthardt, Director Division of Professional Regulation  
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Rod R. Blagojevich, Governor

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Mailing Address
Springfield Office:
320 West Washington St
Springfield, IL 62786   

Chicago Office:
James R. Thompson Ctr
100 W. Randolph St
Suite 9-300
Chicago, IL 60601   

Telephone
Springfield Office:

(217)785-0800
(217)782-3414 For Real Estate Calls
(217)524-6735 TDD
(217)782-7645 FAX
Chicago:
(312)814-4500

PHYSICAL THERAPIST, LICENSED
PHYSICAL THERAPIST ASSISTANT



NOTE: PRINT USING BLACK INK ON WHITE PAPER.
COMPLETE THE APPLICATION AND MAIL ALL PAGES
PARTIAL APPLICATIONS WILL NOT BE PROCESSED

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Examination - Educated Inside the U.S. or one of its Territories   
    THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Licensure Methods and Definitions
    .   Elder and Child Abuse Information
    .   Reference Sheet - A
    .   Application Checklist
    .   Application Jacket
    .   EXAM CT Certification by Licensing Agency/Board
    .   EXAM ED-PT Certification of Education

 
Examination - Educated Outside the U.S. or one of its Territories 

    THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Licensure Methods and Definitions
    .   Elder and Child Abuse Information
    .   Reference Sheet - A
    .   Application Checklist
    .   Application Jacket
    .   EXAM CT Certification by Licensing Agency/Board
    .   ED-PT Certification of Education

 
Physical Therapist/Physical Therapist Assistant- Endorsement

THIS PACKET INCLUDES: . Instruction Sheet . Licensure Methods and Definitions . Elder and Child Abuse Information . Reference Sheet A . Application for Licensure and/or Examination . CT Certification by Licensing Agency/Board . ED-PT Certification of Education
 
Physical Therapist/Physical Therapist Assistant - Acceptance of Examination

THIS PACKET INCLUDES: . Instruction Sheet . Licensure Methods and Definitions . Elder and Child Abuse Information . Reference Sheet A . Application for Licensure and/or Examination . CT Certification by Licensing Agency/Board . ED-PT Certification of Education
 
Continuing Education Out-of-State Approval
THIS PACKET INCLUDES: . PT & PT Asst. CE Sponsor Application
Restoration

  Forms must be obtained from the Department of Professional Regulation.
 

 

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