Mailing List

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's 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.

Requestor Information

Type of Mailing List

Addresses Only $103 ($100 plus $3 processing fee) Email Only $253 ($250 plus $3 processing fee)

Select a Format

Excel Format (.xlsx) Comma Separated Values (.csv)

Requestor's Name

Company Name (if applicable)

Address Line 1

Address Line 2

City

State

ZIP Code Format: 99999, numbers only

Recipient's Email Address

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.

First Name On Card

Last Name On Card

Card Number

Expiration Date Format: mm/yyyy

Email Address (if electronic receipt is desired)

Billing Address

Address

City

State

ZIP Code Format: 99999, numbers only

Confirmation Checkbox

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.

Requestor Signature

Date Format: mm/dd/yyyy

Confirm Finalization

The information you are about to submit cannot be edited after it has been submitted. Please review all fields before finalizing your submission.

Yes, I understand.