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Submit Clinician Information

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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

Name(Required)
ICE Certified?(Required)
Number of ICE Courses Taken?(Required)
Please list your clinical specialties (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.