Submit Clinician Information

PLEASE ONLY ADD YOURSELF IF YOU ARE AN INDEPENDENT HEALTHCARE PROVIDER THAT IS ABLE TO RECEIVE DIRECT REFERRALS TO PERFORM AN EVALUATION & TREATMENT FOR PHYSICAL THERAPY

PLEASE ALLOW UP TO 4 WEEKS FOR YOUR LISTING TO POST

🛑 DISCLAIMER 🛑
🛑 IF YOU ALREADY HAVE AN ENTRY ON THE MAP, STOP AND EMAIL INFO@ICE.PHYSIO WITH CHANGES 🛑
Name(Required)
Number of ICE Courses Taken?(Required)
Hidden
Please select which ICE Certifications you have received (check all that apply)(Required)
Clinic Address(Required)
Accepted file types: jpg, jpeg, png, gif, Max. file size: 256 MB.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 256 MB.