Mississippi Board of Physical Therapy
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Licensure List Request



Licensure lists are available for a fee by following the procedures below. Please fill out this form specifying the desired information. Then you will be taken to the Mississippi State payment system to make your online payment. Both the form and fee are needed to fulfill the request. Assistants are included only if they are specified in your original request. You should allow approximately one business week for our office to process your request.
   
*Format:

Licensee information is available through this office in the following format. Please indicate which format is desired by placing a check mark next to the format requested. The data is in comma delimited format, excel spreadsheet.
Excel spreadsheet format
Self-Adhesive Labels
   
Please indicate how you would like to receive the addresses.
Email
US Postal Service
   
   
*Please check the desired profession(s) requested:
Physical Therapist only
Physical Therapist Assistants only
Physical Therapist & Physical Therapist Assistants
   
The licensure lists are placed in alphabetical order unless otherwise specified. The only information available is license #, name, complete home or work address, email address (depending on signed waiver to release home address and email address), issue date and expiration date.


Indicate in what order the information is desired.
        
   
   
Your Contact Information  
*First Name
Initial
*Last Name
Is this list for:     or   
*Company Name
*Address
Address 2
*City
*State
*Zip
*Phone
*Email
   

If you have any questions regarding this form, you may call 601-352-2918.

Mississippi State Board of Physical Therapy
P.O. Box 55707
Jackson, MS 39296-5707
Phone: (601) 352-2918
Fax: (601) 352-2920
Email: SBoyette@msbpt.ms.gov
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