Address/Name Changes

Reporting Your Address of Record to the PTBC

Per Title 16, California Code of Regulations, Section 1398.6, licensees are required to report to the PTBC their residential address, address of record and email address if applicable.. An alternate address, such as a post office box or place of business, may be listed as your address of record. Your residential address will not be publicly disclosed if you prefer to use an alternate address of record. All PTBC mailings will be sent to your address of record and the same would be disclosed to the public with a written request from any interested party. The Email Address will not be disclosed Licensees are also required to report any subsequent address changes within 30 days of the change, confirming the new and old address as well as the date the address change took effect.

1398.6. Filing of Addresses
(a)Every applicant and licensee shall provide an address to the Physical Therapy Board of California (Board) that will be designated as their address of record, which will be utilized for all official and formal communications from the Board, and which will be disclosed to the public. An applicant or a licensee need not provide a residence address as the address of record, but may use an alternative address, such as a business address or a P.O. Box, as their address of record. Every applicant and licensee shall report any change of the address of record to the Board no later than thirty (30) calendar days after the address change has occurred. The report of change of address of record shall be in writing and contain the old address, the new address, and the effective date of the change of address.
(b) Residence Address. Every applicant and licensee shall provide a residence address to the Board. Only, if the applicant or licensee also provides an alternative address of record as described in subsection (a) above, shall the Board maintain the residence address as confidential. Every applicant and licensee shall report any change of their residential address to the Board no later than thirty (30) calendar days after the address change has occurred. The report of change of residential address shall be in writing and contain the old address, the new address, and the effective date of the change of address.
(c) Name Change. Every applicant and licensee shall report to the Board in writing each and every change of name no later than thirty (30) calendar days after each change has occurred, giving both the old and new names.
(d) E-mail Address. Every applicant and licensee shall file a current e-mail address with the Board and shall notify the Board in writing of any and all changes of the e-mail address no later than thirty (30) calendar days after the change has occurred, giving both the old e-mail address and the new e-mail address. E-mail addresses are confidential information and shall not be made available to the public. This subsection does not require an applicant or licensee to obtain an e-mail address, it only requires that person report an existing e-mail address to the Board.
(e) Licensee. For purposes of this section, "licensee" includes any holder of an active, inactive, delinquent, suspended or expired license, certification or other authorization issued by the Board to practice physical therapy or electromyography which is not canceled or revoked.

How to Report a Name Change

Any licensee who wishes to change the professional name under which he/she practices must complete and submit via mail, fax or email, a Request for Name Change form to the Board along with the required supporting legal documentation.

California law requires each licensee and registrant to report name changes to the Board within 30 days of the name change, providing both the old and new names.

No fee is required to process a name change; however, there are fees to request a duplicate wall certificate and wallet card with the new name.

How to Report an Address Change

You can change your address by downloading the Request for Address Change form and mail, fax or email your changes to the PTBC. If you have more than one license type with the Board select them all, current or delinquent, on your Request for Address Change form.

No fee is required to process an address change; however, there are fees to request a duplicate wall certificate and wallet card with the new address.

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