[Skip to Main Content]

Secretary John M. Colmers

Maryland Crown Logo

Governor Martin O'Malley and Lt. Governor Anthony G. Brown

 Contact Us

Department of Health & Mental Hygiene

         Home |  FAQs | About Secretary Colmers | Secretary Colmers Welcome Message

                             Today is

Maryland Board of Physical Therapy
 
 

Menu
Home
Board News
About the Board
Statutes & Regulations
Board Activities
Licensing Requirements
Continuing Education
License Renewals
Change of Address
License Verifications
Disciplinary Actions
How to File a Complaint
Forms & Applications 
Newsletters
Frequently Asked Questions
Contact Information
Miscellaneous
Terms of Use
Other Licensing Boards
DHMH Home
 

 

 

Page Last Updated:

03/17/2010

 

Change of Address Form

By law, you must notify the Board immediately of any change of address. Further, you could be fined $100 for not doing so.

 

 

Name:   License No.

Old Address:

New Address:

City:    State:   Zip Code:

Phone No.    Email:

 

 

 

 

  

 

Links marked with This is a .pdf file and requires Acrobat Reader are PDF.  Download Adobe Acrobat Reader for viewing .pdf files

General Information: (410) 764-4751
Technical Problems/Site Suggestions, send email to: The Web Master
MD Relay Number: 1-800-735-2258

(For best results, view at 800 x 600 with Microsoft Internet Explorer)
Copyright © 2002 Maryland Department of Health and Mental Hygiene (DHMH)