Professional Credential Services, Inc.
P.O. Box 198689 - Nashville, TN 37219-8689
www.pcshq.com
Examination & Licensure Application for
Physical Therapists
For the
Massachusetts Board of
Allied Health Professionals
_______________________________________________________________
If you have ever held a Massachusetts license as a
Physical Therapist or Physical Therapist Assistant,
please contact the Allied Health Board office at
(617) 727-3071 for information about, and an application
for reinstatement of your original license.
The Massachusetts Board of Allied Health Professionals (the Board) has authorized Professional
Credential Services (PCS) to process all of its applications for examination and licensure for physical
therapy. Applicants for a license in physical therapy must submit all of their information, as
indicated in these instructions, directly to PCS. The Board is the final authority with respect to
issuance of the license.
INSTRUCTIONS
A licensure application is included in this packet. You may register with FSBPT at www. FSBPT.net.
The licensure application must be typewritten or printed in blue or black ink. Include all components
of the requested information, especially names and addresses of institutions. All documents must
have original signatures. All questions on both applications must be answered.
REQUEST FOR INFORMATION
Applicants may contact PCS to obtain information, ask questions about application processing, or
receive status updates by telephone or email.
Applicants may register and check examination status at www.FSBPT.net
PCS Staff is available Monday through Friday, 8:00am to 4:30pm., C.S.T.
Please allow three to four weeks for processing of application.
EXAMINATION INFORMATION
Those applicants who have NOT yet taken National Physical Therapy Examination (NPTE) must
register at www.FSBPT.net. Upon review of your academic credentials, PCS staff will approve your
registration to FSBPT which will send an authorization to test and scheduling instructions directly to
you. The applicant has sixty (60) days from the date of receipt of the Authorization to Test Notice to
schedule the computerized examination. FSBPT will score the examination, and submit scores to
PCS. PCS will notify you of the examination results.
LICENSURE INFORMATION
Applicants for PT licensure must show proof of passing the National Physical Therapy Examination
(NPTE). Official transcripts with degree conferral and documentation of all academic and fieldwork
requirements must also be submitted before a license is issued. If a transcript is not available, the
CERTIFICATION OF COMPLETION OF EDUCATIONAL REQUIREMENTS form must be submitted
with the application. Thereafter, an official transcript MUST be forwarded to MA Board of Allied Health
Professionals, c/o PCS PT/PTA Coordinator, P.O. Box 198689, Nashville TN, 37219 within seven
(7) business days of degree conferral. Transcripts must be included in school-sealed envelopes.
Applicants will need to request license verification be sent from all states they have held a license in
whether active or inactive. Applicant may register online at www.FSBPT.net to have their Score
Transfer electronically sent to PCS.
To obtain more information on-line about PT/PTA examination and licensure requirements, visit:
www.mass.gov/dpl/boards/ah or www.FSBPT.net
FEES FOR EXAMINATION & LICENSURE
Licensure by Examination and Endorsement must submit total payment of $226.00. Payment must
be made to PCS by check, money order, or with a MasterCard or Visa. FEES SUBMITTED CANNOT
BE REFUNDED OR TRANSFERRED.
FOREIGN-EDUCATED APPLICANTS SEEKING LICENSURE
Applicants for licensure as Physical Therapists who have completed a program in a foreign
jurisdiction that has not been accredited (i.e. NOT a state or territory of the United States, the District
of Columbia, or the Commonwealth of Puerto Rico) shall be required to:
1. Demonstration of Proficiency in English Language
If English is not an applicant’s first language, a passing score of 560 or higher on the
TOEFL and a passing score of 4.5 or higher on the TWE are required for licensure. Official
notice of a passing score must be provided to PCS. For more information, contact
TOEFL/TWE Services, PO Box 6151, Princeton, NJ, 08541-6151; tel. (609) 771-7100.
2. Verify Credentials
FCCPT (Foreign Credentialing Commission on Physical Therapy) is the only credential
evaluation service approved by the Board:
a. Educational credentials must be evaluated and found to be equivalent.
b. Evidence must be provided that the applicant is authorized to practice his specific
discipline without restriction in the legal jurisdiction in which the post secondary
institution from which the applicant has graduated is located or in the legal jurisdiction
in which the applicant is a citizen.
Candidates may contact: FCCPT, 511 Wythe Street, Alexandria, VA, USA 22314
Best point of contact: www.fccpt.org
MATERIALS TO BE SUBMITTED
If you are applying for LICENSURE BY EXAMINATION:
1. Completed licensure application.
2. Official transcripts or Certificate of Completion only if transcripts have not been
conferred; and FCCPT Foreign Evaluation for all Foreign-educated candidates or
FCCPT Type 1 Certificate for all applicants trained outside the U.S.
3. Check or money order for $226.00 made payable to PCS, or a Visa or MasterCard
charge authorization for $226.00.
If you are applying for LICENSURE BY ENDORSEMENT:
1. Completed licensure application.
2. Official transcripts or Certificate of Completion, and FCCPT Foreign Evaluation for all
Foreign-educated candidates
3. Official verification of licensure status in all states in which you have ever been
registered or licensed
4. A report of your score on the NPT Examination (to be submitted directly from FSBPT’s
Score Transfer Service. You may request your Score Transfer be sent electronically at
www.FSBPT.net
5. Check or money order for $226.00 made payable to PCS, or a Visa or MasterCard
charge authorization for $226.00.
MAIL COMPLETED APPLICATION MATERIALS TO:
Professional Credential Services, Inc.
Attn: PT/PTA Coordinator
P.O. Box 198689
Nashville, TN 37219-8689
Professional Credential Services, Inc.
P.O. Box 198689 - Nashville, TN 37219-8689 (877) 887-9727
Application for a Massachusetts PT License
Type of License: Physical Therapist
Type of Applicant: Licensure by Examination - $226.00 Licensure by Reciprocity/Endorsement - $226.00
A. Biographical Information.
Provide your full name and
mailing address. It is very
important that this section be
completed in full.
B. Education.
Provide ALL undergraduate
and graduate college/university
information, major, degree,
and date of graduation,
inclusive of your PT/PTA
College, if applicable. If a
Certification of Completion of
Educational Requirements is
initially submitted with this
application, please review the
Licensure Information section
of the application instructions.
C. NPT/NPTA Examination. You
must register at
www.FSBPT.net if you have not
taken the examination.
D. Licensure by Endorsement.
This section is applicable to
persons holding a current or
lapsed license as a Physical
Therapist or Assistant issued by
another state. List all states in
which you hold or held a
license, including
Massachusetts. If additional
space is needed, please attach
a separate sheet.
______________________________________________________________________________________
First Name Middle Initial Last Name Other (Maiden)
_______________________________________________________________________________________
Print your name, as it should appear on your license
Mailing Address and Contact Information
_______________________________________________________________________________________
Street or PO Box
_______________________________________________________________________________________
City State Zip Code
_______________________________________________________________________________________
Telephone Number with Area Code Fax Number Email address
Have you taken the NPT Examination? Yes No Date Taken:________________
If you have taken the Examination, a score report from the Federation of State Boards of Physical Therapy
(FSBPT) is required. You may request an Electronic Score Transfer be sent to PCS at www. FSBPT.net
Have you ever been licensed or are you currently licensed in another state or U.S. jurisdiction?
Yes
No
If yes, please complete the following:
State
License Number
Date Licensed
Current
Lapsed
Revoked/Suspended
Probation
If you have ever been licensed to practice as a PT or PTA in another state, you must make arrangements with
each state to send verification of licensure status, either current or expired, directly to Professional Credential
Services (PCS). It is the applicant’s responsibility to notify the state and pay any fees required by another
licensing state. A copy of your license is NOT acceptable as verification. The verification must have the official
state seal.
Undergraduate
College/University
Location
Major
Undergraduate
Degree & Date of Graduation
Graduate
College/University
Location
Major
Graduate
Degree & Date of Graduation
E. Questions. Answer each of the
questions listed. If you answer
yes to any, please attach an
explanation. All questions must
be answered.
F. General Questions – Chapter
66.7. ALL APPLICANTS
MUST COMPLETE THE
FOLLOWING SECTION. The
following questions are a
sample of the information
contained in Massachusetts
General Laws, Chapter 112,
Sections 23A-23Q and the
Rules and Regulations of the
Board. The purpose of these
questions is to heighten your
awareness of the laws and
regulations in which you are
required to practice.
1. Has any disciplinary action been taken against you by a licensing or certification
board located in the United States or any country or foreign jurisdiction?
2. Are you the subject of pending disciplinary action by any licensing or
certification board located in the United States or any country or foreign
jurisdiction?
3. Have you voluntarily surrendered or resigned a professional license to
a licensing or certification board in the United States or any country or
foreign jurisdiction?
4. Have you ever applied for and been denied a professional license in the
United States or any country or foreign jurisdiction?
5. Have you ever been convicted of a felony or misdemeanor in the United States
or any country or foreign jurisdiction?
6. Are you presently practicing / working as a Physical Therapist or Physical
Therapist Assistant? If yes, please state where you are working, when
you started, and what your duties include.
___________________________________________________________________
___________________________________________________________________
7. Have you ever been named in a malpractice suit?
If yes, please explain.
1. How many support personnel is a physical therapist (PT)
allowed to supervise?
a. Unlimited
b. Not more than four (4) at one time
c. One (1) PTA
d. As many as the PT determines they can safely supervise to
ensure the quality and safety of the care provided
______________________________________________________
2. The primary responsibility for the care rendered by supportive
personnel rests with:
a. The supervising physical therapist assistant
b. The supervising physical therapist
c. The physical therapist compliance officer
d. The physical therapy facility owner
3. An applicant for licensure as a physical therapist shall:
a. Be a graduate of a three or four year secondary school or has
passed a high school equivalency test deemed acceptable by
the board
b. Be a graduate of an accredited educational program leading to
professional qualification in physical therapy and approved by
the board
c. Have passed an examination administered by the board
d. All of the above
YES NO
4. An applicant for licensure as a physical therapist who graduated from an
educational program outside the United States shall provide evidence to the board
that
a. Evidence that the education is substantially equivalent to that of graduates of
approved programs in the United States
b. Proficiency in the English language, to practice physical therapy
c. Evidence of physical therapy licensure outside of the United States
d. All of the above
_____________________________________________________________________
5. Designations allowed in the commonwealth are
a. SPT or SPTA
b. PT or PTA
c. DPT
d. All of the above
_____________________________________________________________________
6. Under what circumstances may a PTA perform an initial evaluation and develop a
PT plan of care
a. When the supervising PT delegates this activity to him/her
b. Initial evaluations and development of plans of care are beyond the scope of
practice for the physical therapist assistant
c. If the supervising PT is not available to perform the initial evaluation and establish
the plan of care
d. When he/she does not have a supervising physical therapist
____________________________________________________________________
7. A physical therapist and physical therapist assistant must renew his/her license
a. Every two years on his/her birthday
b. Every two years on January 31
st
in even years
c. Annually on December 31
st
in add years
d. Annually on the last day of his/her birthday month
____________________________________________________________________
8. A PT or PTA who does not renew his/her license by the expiration date can legally
continue to practice?
a. If he/she did not receive a renewal application from the board
b. As long as he/she works under the supervision of a fully licensed therapist
c. If she/he intends to renew it as soon as they get an opportunity
d. No, it is never legal to practice in MA without a current license
____________________________________________________________________
9. A physical therapy facility license is required if
a. The facility operates within the Commonwealth and employees physical therapists
and /or physical therapist assistants
b. A physical therapists is engaged in a solo practice
c. The physical therapy practice is regulated by the Mass Department of Public Health
d. The physical therapy practice is regulated by the Mass Department of Education
____________________________________________________________________
10. Every licensed physical therapy facility must have a physical therapist compliance
officer (PTCO) who must
a. Be of good moral character
b. Notify the board within five(5) business days of ceasing to serve as a PTCO
c. Notify the board of any known disciplinary actions or criminal convictions against
any person having more than ten percent ownership interest, company officers,
principals, employees of the facility
d. All the above
G. Affidavit. By signing this
application, the applicant
attests that this section has
been read and fully
understood. The application
must be signed by the
applicant and in the presence
of a Notary Public in order to
be processed.
Please be sure to write your
date of birth and Social
Security Number in numbers
1 and 2.
H. Applicant Signature.
Applicant MUST sign in the
presence of a Notary Public,
and list date of birth.
I. Special Accommodations.
In accordance with the
Americans with Disabilities
Act, special Accommodations
may be provided at the
examination site for applicants
who qualify.
By my signature below, I certify, under the pains and penalties of perjury, that:
1. I am the applicant named in this application and by date of birth is _____MM _____DD_____YY
2. My Social Security Number issued by the US Social Security Administration is ________ - ______ - ______*
3. The information that I have provided pursuant to this application is truthful and accurate. I understand
that the failure to provide accurate information may be grounds for the Board of Allied Health
Professionals to deny, suspend, or revoke a license to practice as a Physical Therapist or Assistant, in
accordance with Massachusetts law.
4. I shall abide by the rules and regulations of the Board of Allied Health Professionals, as contained in
Chapter 259 of the Code of Massachusetts Regulations.
5. Pursuant to M.G.L.c. 119, s. 51A, and M.G.L.c. 112, s.1A, I understand my obligation to report the
abuse or neglect of children.
6. Pursuant to M.G.L.c 62C, s. 49A, to the best of knowledge and belief, I have filed all Massachusetts
State income tax returns and paid all taxes required by law.
7. The Massachusetts Board of Registration of Allied Health Professions, Division of Professional
Licensure, has been certified by the Criminal History Systems Board for access to all criminal case
data. As an applicant for PT/PTA license, I acknowledge a criminal record check may be conducted
for any existing criminal case information and that it will not necessarily disqualify me from licensure.
8. I understand that this application is abandoned if requirements for licensure are not met within one (1)
year from the date of Board receipt of the application.
9. I understand that all fees are non-refundable and non-transferable.
10. I understand that if I submitted a Certification of Completion in lieu of an official transcript, I must
ensure that the Board of Allied Health Professionals receives an official transcript within seven (7)
business days of degree conferral. I further acknowledge that failure to do so will cause a delay in
renewing my license and/or effectuate disciplinary action.
11. I am aware that under Massachusetts law, physical therapists and physical therapist assistants can
only work in licensed or licensed exempt facilities.
Applicant’s Signature (signed in the presence of a Notary Public)
*Pursuant to G.L. c. 62C, s. 47A, the Division of Registration is required to obtain your Social Security Number and forward
it to the Department of Revenue. The Department of Revenue will use your Social Security Number to ascertain whether
you are in compliance with the tax laws of the Commonwealth. Accordingly, no application will be PROCESSED without
the inclusion of YOUR valid Social SECURITY NUMBER.
On this ______ day of _________________________, 20_______, before me, the undersigned notary public,
personally appeared ___________________________________________ (Applicant’s name), proved to me
through satisfactory evidence of identification, which were ________________________________ (type of
identification presented), to be the person who signed the preceding or attached document in my presence,
and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of
(his) (her) knowledge and belief.
_________________________________________________ (Official signature)
_________________________________________________ (Name & commission expiration of Notary)
Check here if you require special Accommodations at the examination site for a disability. Please
attach official medical documentation from your health care provider describing your condition. On
a separate piece of paper, you must also indicate the type of modifications needed.
Affix Seal of
Notary
Professional Credential Services, Inc.
P.O. Box 198689 ~ Nashville, TN 37219-8689 (877) 887-9727
________________________________________________________________
Certification of Completion of Educational
Requirements
Licensure applicants for the Commonwealth of Massachusetts who are currently enrolled in an academic program, and
whose degree in physical therapy has not yet been conferred, must have the school registrar complete this to be
submitted to PCS.
NOTICE TO REGISTRAR: This form is not to be signed, dated or submitted prior to completion of academic and
clinical requirements by the candidate. Further, the Registrar certifies that the institution will forward an official transcript
within seven (7) business days of degree conferral to the Mass. Board of Allied Health Professionals c/o PCS PT/PTA
Coordinator, P.O. Box 198689, Nashville, TN 37219
-------------------------------------------------------------------------------------------------------------------------------------
TO BE COMPLETED BY REGISTRAR ONLY
__________________________________________________________________
Applicant Name Student ID number
___________________________________________________________________________________________________
Name of Educational Institution Degree & Date of Degree Conferral (required)
___________________________________________________________________________________________________
Street Address City, State ZIP Code
_____________________________________________ ________________________________________________________
Date of Completion of Academic Requirements Date of Completion of Clinical Requirements
I certify, under penalty of perjury, that the applicant named above has completed all requirements and there are no
impediments to confer the degree stated above. Upon payment of required fees and permission from the applicant, I
certify that an official transcript will be forwarded to the Mass. Board of Allied Health Professionals c/o PCS PT/PTA
Coordinator; P.O. Box 198689, Nashville, TN 37219 within seven (7) business days of degree conferral.
_________________________________________________
Signature of Registrar
____________________________________________________
Print Name
School Seal
(Embossed)
____________________________________________________
Date Telephone Number
Send this completed form in sealed envelope to PCS, PT/PTA Coordinator, P.O. Box 198689, Nashville, TN 37219
Send official transcript in sealed envelope to PCS, PT/PTA Coordinator, P.O. Box 198689, Nashville, TN 37219
Three payment options are available: Certified Check, Money Order or Credit Card. If paying by
Certified Check or Money Order, please make it payable to “PCS” for the total amount of the
examination(s) you are applying to take. DO NOT staple your payment to this form.
Please check form of payment below:
Certified Check
Money Order
Credit Card
Authorized payment amount: $ ______ Please check one: Visa or MasterCard
Card Number: _________-__________-___________-___________ Exp: /
Print name as it appears on account:
Authorized Signature:
Return this payment form with Application/Scheduling Form.
Note: This document will be shredded after it has been processed.
Payment Form
Use the enclosed Payment Form to submit payment.
