If you trained as a physical therapist outside the United States, the NPTE is one step in a longer process. Before you can sit the exam, your education has to be judged equivalent to a US degree, and most states want proof of English proficiency. Here's the path, step by step, using FSBPT's guidance for non-US candidates.
Can internationally educated PTs take the NPTE?
Yes. You can take the NPTE if a recognized credentialing agency finds your physical therapy education substantially equivalent to a US degree from a CAPTE-accredited program, and your state licensing board approves you. Most states also require a TOEFL score. To work in the US, you also need permission from US immigration authorities, which is a separate process from licensure.
FSBPT's Non-US Candidates page puts it simply: you need "permission to work in the United States" and a "physical therapy license." Each state sets its own licensure rules, so start with the board where you plan to practice.
Step 1: Get your education credentials reviewed
A credentials review compares your education, course by course, with the first professional degree of a CAPTE-accredited US program. Independent agencies do the review. They collect your original documents, verify that they're authentic and that your school was recognized, and check the official syllabi for the required content (FSBPT Education Credentials Review).
- If content is missing, your education is found "not equivalent," and you can make up the gap with supplemental coursework from an accredited college or university.
- FSBPT's Coursework Tool (CWT) is the standard tool most boards accept. It reflects the requirements that applied in the year you graduated.
- Some states specify which agencies they accept, so check with your board before you pay for a review.
| Organization | Uses FSBPT Coursework Tool | USCIS Health Care Worker Certificate |
|---|---|---|
| Foreign Credentialing Commission on Physical Therapy (FCCPT) | Yes | Yes |
| TruMerit (formerly CGFNS) | – | Yes |
| International Consultants of Delaware (ICD) | Yes | – |
| International Education Research Foundation (IERF) | Yes | – |
| University of Texas at Austin (Texas only) | – | – |
Source: FSBPT Credentialing Organizations for Non-US Candidates. Only FCCPT and TruMerit are recognized by US Citizenship and Immigration Services (USCIS) to issue Health Care Worker Certificates for visa purposes.
Step 2: Meet the English-language requirement
FSBPT says the TOEFL is the only English proficiency test it and USCIS accept for physical therapists. Required scores are set by each state. In FSBPT's licensure guide, 44 jurisdictions require TOEFL for licensure by examination, and the most common standard is Writing 24, Speaking 26, Reading 21 and Listening 18.
- State standards vary. Twenty jurisdictions use 24/26/21/18. Seven use the federal Type 1 standard: a combined Writing, Reading and Listening score of 63, and Speaking 26. California requires Reading 22, Listening 21, Writing 22, Speaking 24, and Arizona requires 25 in every section (FSBPT Licensure Reference Guide).
- Exemptions for immigration: USCIS doesn't require the TOEFL if you earned a bachelor's degree or higher in the United States, United Kingdom, Ireland, Australia, New Zealand, or Canada (except Quebec), or graduated from a CAPTE-accredited program. A state board may still require it for licensure (FSBPT, Other Requirements for FEPTs).
ETS runs the TOEFL. Check your state board's current score rules and how they apply to the version of the test you take.
Step 3: Apply to your state and register for the NPTE
- Apply for licensure with the board in the state where you plan to practice. Every jurisdiction must approve candidates who didn't attend a CAPTE-accredited program.
- Request an FSBPT profile. Graduates of non-CAPTE programs request one through FSBPT's Customer Login page. If you don't have a US Social Security Number, you're assigned an alternate ID. Allow three business days.
- Register and pay ($485 plus a 1.6% processing fee). Unlike CAPTE graduates, you can register at any time; FSBPT advises contacting your state first.
- Wait for state approval before the jurisdiction deadline, then schedule at Prometric. FSBPT's Candidate Handbook describes the NPTE as given at Prometric centers throughout the United States. Every window is on our NPTE exam dates page.
Step 4: Other state requirements
Some jurisdictions require a period of supervised clinical practice in a US setting before licensure, and may need to approve the facility, the supervisor, or both. Some states also require a jurisprudence exam or jurisprudence assessment module on their practice laws. Your board's application instructions list what applies to you.
Pass rates for internationally educated candidates
| Exam year | Educated outside the US | US-educated |
|---|---|---|
| 2025 | 39% | 85% |
| 2024 | 39% | 86% |
| 2023 | 40% | 84% |
| 2022 | 41% | 85% |
| 2021 | 45% | 89% |
First-time pass rates for candidates educated outside the US have been 39–45% over the last five years (FSBPT exam year reports). That's a gap of more than 40 points, and it's worth planning for. FSBPT's own remediation advice for this group focuses on programs that assess and remediate against a CAPTE-equivalent education, and on English-language skills.
How to prepare if you were educated abroad
- Learn the US practice context. Professional responsibilities, such as documentation, billing, HIPAA, PT and PTA roles, and state regulation, make up part of the exam and are specific to US practice. See the NPTE content outline.
- Practice clinical reasoning in English with long, scenario-based questions, at about 80 seconds per question.
- Take FSBPT's PEAT for a score estimate on a retired NPTE form before you commit to a date.
- Plan for more time. A 12-week or longer NPTE study plan makes sense for most internationally educated candidates.
Frequently asked questions
Which credentialing agency should foreign-educated PTs use?
Check with your state board first; some specify which agencies they accept. FSBPT lists FCCPT, ICD and IERF as licensed to use its Coursework Tool, and FCCPT and TruMerit as the two agencies USCIS recognizes for Health Care Worker Certificates.
What TOEFL score do physical therapists need?
It depends on the state. The most common requirement in FSBPT's licensure guide is Writing 24, Speaking 26, Reading 21 and Listening 18. Others use the federal standard (a combined 63 for writing, reading and listening, plus speaking 26), and a few set their own scores.
Where can I take the NPTE?
At Prometric test centers. FSBPT's Candidate Handbook describes the exam as administered at Prometric centers throughout the United States, and you can test at any center offering the NPTE, whatever state you registered for. Confirm current locations with FSBPT and Prometric when you schedule.
What is the NPTE pass rate for foreign-educated PTs?
FSBPT reports a first-time pass rate of 39% for candidates educated outside the US in 2025, compared with 85% for US-educated candidates.
Do I need a visa before taking the NPTE?
Licensure and immigration are separate processes. You need a state license to practice and USCIS permission to work in the US. USCIS may require a Health Care Worker Certificate, which only FCCPT and TruMerit can issue.
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Every figure on this page comes from the primary sources below, checked on September 27, 2026. If an official source changes, it overrides this page.
- Non-US Candidates — FSBPT
- Education Credentials Review (Foreign Educated PTs and PTAs) — FSBPT
- Credentialing Organizations for Non-US Candidates — FSBPT
- Jurisdiction Licensure Reference Guide: Initial Licensure — Foreign Educated PTs and PTAs (TOEFL) — FSBPT
- Other Requirements for FEPTs/PTAs (TOEFL, supervised clinical practice) — FSBPT
- NPTE Exam Year Reports (pass rates by exam year) — FSBPT