Nevada State Board of Physical Therapy Examiners
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
-----------------------
REQUEST FOR LICENSE VERIFICATION
Please Type or Print Legibly
Rev. 12/27/2017
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.