Physical Therapy Board of California

Reporting Your Name Change

Pursuant to Title 16, California Code of Regulations, Section 1398.6, applicants and licensees are required to report in writing to the PTBC each name change no later than thirty (30) calendar days from the date the change occurred.

How to Report Your Name Change

Submit a Request for Name Change online.

  Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)

Effective January 1, 2024, under Business and Professions Code section 27.5, licensees may notify the licensing board or bureau within the Department of Consumer Affairs (DCA) of a name and/or gender change and request confidentiality of the previous name or gender information, when meeting certain specified requirements. For more information and to make a request, click here.

  Name Change FAQ

No fee is required to change your name.  However, if you would like your new name displayed on your wallet license, you will need to request a pay for a duplicate license. You can request a duplicate license online as well.

You must submit:

  1. A current government issued photographic identification (e.g., driver license, alien registration, passport, etc.
  2. One of the following legal documents as proof of name change:
    1. Certified court order
    2. Marriage certificate
    3. Dissolution of marriage (Divorce)

Name changes are processed within one week of all required documentation being received.