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*

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Payment Information

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.

Requestor Signature


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