Name Change

Make sure to have the following information before you begin the name change process:

1. Your first and last name;
2. Your social security number;
3. Your PT/PTA license number;
4. A Legal Document in PDF format that indicates the name change that can be uploaded;
5. A current Visa or MasterCard account;
6. The expiration date of the Visa or MasterCard account.

If you require an updated wall certificate it will cost $20.00. An updated wall certificate will be mailed to you once the payment has been approved.

All information entered will be encrypted, so your data will be transmitted safely and securely.