Florida, Texas, California, Montana, Nevada, Nebraska and Alaska require the NBCE Physiotherapy exam for exam-route licensure. New York does not, and Alabama and Arizona do not list it. The NBCE calls PHT elective; it has 90 questions, costs $450, and requires 120 hours of documented physiotherapy instruction to sit.
The NBCE Physiotherapy exam (PHT) is optional as far as the National Board of Chiropractic Examiners is concerned, and required as far as many state boards are concerned. Florida, Texas, California, Montana, Nevada, Nebraska and Alaska all list it for exam-route licensure. New York says outright that it does not need it. If you are licensed in a state that never asked for PHT and you are moving to one that does, expect to take it.
What is the Physiotherapy exam?
The NBCE's Physiotherapy page describes it as an elective, computer-based exam of 90 multiple-choice questions with 75 minutes of testing time. It is given on chiropractic college campuses and at Prometric testing centers. The fee on the NBCE's 2026 fee schedule is $450, and the NBCE recommends a passing score of 375 while noting that individual states may require a higher one.
To sit for it, the NBCE requires 120 hours of physiotherapy instruction completed before the application deadline, from or recognized by a chiropractic college whose students are eligible for NBCE exams. That requirement is the snag for some older graduates: the coursework has to be documented, not just remembered.
Which states require it?
From the rules and board pages we have read, as of October 2026:
- Florida: Fla. Stat. § 460.406(1)(e) and Rule 64B2-11.001 require PHT at 375, alongside Parts I to IV.
- Texas: 22 Tex. Admin. Code § 72.6 requires PHT at 375. Texas endorsement applicants also need it unless they qualify on SPEC (§ 72.20).
- California: 16 CCR § 349(b) includes Physiotherapy in "National Board status."
- Montana, Nevada and Nebraska: PHT is part of the exam route in each. Montana's endorsement rule says PHT must be shown separately if the applicant's original state did not require it (Mont. Admin. R. 24.126.504). Nebraska requires it on both of its routes for out-of-state licensees.
- Alaska: Graduates after September 1, 1998 need PHT for the exam route; the credentials route accepts physiotherapy training or the exam (12 AAC 16.033, 16.037).
Which states do not require it?
- New York. The NYSED chiropractic requirements page states that "the NBCE 'Physiotherapy' exam subject is not required for New York State licensure."
- Alabama. The board's licensure rule lists Parts I to IV, or Parts I and II plus SPEC, and does not list Physiotherapy (Ala. Admin. Code r. 190-X-2-.01).
- Arizona. Physiotherapy is not a licensing requirement there. Arizona instead issues a separate board certificate before a DC offers physical medicine modalities (A.R.S. § 32-922.02). That is a second filing, not a substitute for the license.
Each state's current position is on its page in our state license index.
Why does this trip up experienced DCs?
Because the requirement follows the destination state, not the one where you trained. A doctor licensed for 15 years in New York may never have taken PHT. If that doctor applies in Florida or Texas, the missing exam is usually the first deficiency the board notes. It is easy to fix but it takes time: an NBCE application, an appointment, a score, and an updated transcript sent to the board. See sending NBCE scores to a new board.
Two checks before you file anywhere new:
- Look at your NBCE transcript. If PHT is not on it, it was not passed or not released. The NBCE transcript shows your most recent passing scores only.
- Find your physiotherapy coursework. If you have to sit for PHT now, you will need the 120 hours documented by an eligible college.
A framed certificate does not settle it either. The NBCE issues a separate Certificate of Attainment for Physiotherapy, apart from the one for Parts I to IV, but Texas and New York, for example, want results sent directly by the NBCE (22 Tex. Admin. Code § 72.6(b); NYSED requirements page), not a copy you mail in.
Does passing PHT let me use physiotherapy modalities in a new state?
No. PHT is an exam a board may require for a license. What modalities a DC may use, and whether a separate certificate or registration is needed first, is set by each state's practice act. We file the registrations a state requires, such as Arizona's physical medicine certificate, through our Scope Add-On Registration service ($249 per registration), but we do not advise on scope.
If you are not sure whether PHT is the gap in your file, our Chiropractic Licensure Readiness Review ($149) compares your NBCE transcript with the target state's rules before you pay any board fee.
Common questions
- Is the NBCE Physiotherapy exam required?
- Not by the NBCE, which calls it elective. Many states require it for licensure, including Florida, Texas and California. New York states that it is not required there.
- How much is the Physiotherapy exam?
- $450 on the NBCE's 2026 fee schedule. A 50-question sample test costs $15.
- I never took PHT. Can I take it years after graduating?
- Yes, if you can document 120 hours of physiotherapy instruction from or recognized by an eligible chiropractic college, which is the NBCE's eligibility rule.
- Does the destination state care that my first state did not require PHT?
- Usually yes. Montana's rule, for example, says an endorsement applicant must show PHT separately if the original state did not require it.
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