Mailing List Request

The Louisiana Physical Therapy Board offers an electronic mailing list of active licensees in the state agreeing to have their information shared with third parties. The list contains each licensee'ss first and last name, license type, and either mailing address (street address, city, state, and zip code) OR email address. Responses are emailed within three business days of receipt of the request and payment.

Type of Mailing List*

Select a Format*

Requestor's Name

Company Name (if applicable)

Address

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Please send the Mailing List to this Email Address

Acceptable forms of payment are Visa, MasterCard, Discover, or American Express credit cards.
A $3.00 processing fee will be applied to credit card payments.

Name On Card

Credit Card Number

Exp Date

Email Address (if electronic receipt is desired)

Billing Address

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

By electronically signing, I agree not to resell, nor to make available to another agency pursuant to another arrangement, the data obtained from the Louisiana Physical Therapy Board produced pursuant to this order form. I further agree not to hold the Louisiana Physical Therapy Board responsible for changes in names, addresses, or licensure status of licensees, which occur after the data is produced.