Physical Therapist Registration Basic Information Username* E-mail* First Name* Last Name* Physical Therapy Credential* Physical Therapist (PT)Physical Therapy Assistant (PTA)Physical Therapy AidePhysical Therapy Student Choose the level of your therapist credential License Number(s)* Enter your License Number(s) including the state where the license was issued. If you hold multiple licenses, place a comma between each credential. (Example: IL 08210000158, IL 08230000203)Clinical Practice Information Facility Name* Country* USAUS Virgin IslandsCanadaMexicoOther City* State/Province* ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMTNENVNHNJNMNYNCNDOHOKORMDMAMIMNMSMOPARISCSDTNTXUTVTVAWAWVWIWYCA-AlbertaCA-British ColumbiaCA-ManitobaCA-New BrunswickCA-Newfoundland / LabradorCA-Nova ScotiaCA-OntarioCA-Prince Edward IslandCA-QuebecCA-Saskatchewan Password InformationCreate a password that you can easily remember. Password* Minimum length of 6 characters. The password must have a minimum strength of WeakStrength indicator Repeat Password* Send these credentials via email.
