Understanding the Landscape: Dry Needling & Physical Therapy Practice Acts in the U.S.

Dry needling has grown rapidly in clinical physical therapy practice, yet state practice acts and Board regulations vary in how they define the physical therapy scope as it relates to dry needling and what they require for clinicians to perform the skill legally and safely. 

At its core:

• Physical therapy practice acts are state-specific laws and regulations that define what therapists may legally do under a PT license in said state.

• Dry needling may be expressly included in that scope, deemed prohibited, or simply not mentioned at all (silent).

• Even in states that allow it, many Boards place additional education and competency standards on physical therapists before they can clinically perform dry needling.

Where Dry Needling is Allowed for Physical Therapists

As of January 2026, most states and Washington, D.C. expressly permit dry needling as part of the PT scope of practice. Depending on the source reviewed, this list can vary slightly as state rules evolve.

Allowed

Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and Washington, D.C. 

In these states, physical therapists may legally perform dry needling as long as they stay within their scope and meet state board educational and competency requirements. 

States Where Dry Needling is Prohibited for PTs

A smaller group of states continues to prohibit physical therapists from performing dry needling, often because the state board and/or legislature have defined the skill as part of acupuncture practice, requiring a separate license. 

Prohibited States

• California

• Hawaii

• New York

• Oregon

Currently, in these states, performing dry needling without additional licensing as an acupuncturist (or equivalent) can expose a therapist to regulatory action. 

States Where Practice Acts Are Silent or Ambiguous

Several states do not explicitly address dry needling in their statutes or Board regulations. In these places, physical therapists may not have clear legal authorization, and many Boards recommend caution, following regulations that are established by the FSBPT, and/or case-by-case interpretation. 

Silent / Undefined

• Connecticut

• Massachusetts

• Michigan

• Minnesota

• Missouri

• Oklahoma

• Pennsylvania

  
  

Because silence does not equal authorization, physical therapists in these states often consult their Board before incorporating dry needling into practice.

Here is a current map of the states that allow dry needling, states that have no opinion and states where dry needling is prohibited:

Training & Competency Requirements

Even in states that allow dry needling, the practice act or Board regulations usually requires physical therapists to meet additional training and competency standards. No uniform national training exists yet, so states differ in what they require. Common components of dry needling requirements can include Board-specific advanced education hours, supervised clinical experience, required competency assessments, required registration with the Board specific to dry needling practitioners and/or Board-specific documentation and informed consent standards.

Advanced Education Hours

Many states require specific, post-professional dry needling education course hours that range from 24–80 hours. For example:

• Arizona mandates a minimum of 24 hours of dry needling education training, completion of a written and practical exam and proof of compliance must be submitted to the Board within 30 days of course completion.

• Colorado requires physical therapists to complete 50 hours continuing education in dry needling, 40 of those hours must be face-to-face, 10 of those hours can be online education; it is required that PTs complete 30 hours prior to clinic use and clinicians must complete their dry needling educational requirements within 4 years from their onset of their first dry needling educational program.

• Maryland requires 2 years of licensed practice, 80 face-to-face hours (40 hours of theory and 40 hours practical) before integrating dry needling into clinical practice; the therapist must also register with the Board of Examiners ($100 one time fee) and turn in a notarized self-certification form to the Board.

Other states with specific hours requirements include: Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Mississippi, Nevada, New Jersey, New Mexico, North Carolina, Tennessee, Utah, Washington and Wyoming.

This becomes important when you are choosing a course to enroll in. You'll want to understand how many hours the course is approved for to ensure that you're optimizing hours for each enrollment. It is why we offer both 2 day and 3 day model courses at PPHC. Our 2 day course is approved for 30 CEUs (20 in-person, 10 online) and our 3 day course is approved for 40 CEUs (30 in-person, 10 online).

Supervised Clinical Experience

Some states require an additional number of supervised patient sessions. For example:

• Florida specifies a requirement for 25 supervised patient sessions under a physical therapist who holds an active license, who has actively performed dry needling for 1 year, and who documents that the supervised PT has met the supervision and competency requirements and needs no additional supervised sessions to perform dry needling. 

• Illinois specifies 200 supervised patient treatment sessions

• Washington specifies 150 sessions for review that must be completed within 18 months and physical therapists must also apply for endorsement upon completion of dry needling education requirements.

Other states with specific supervised or logged sessions include: Kansas and Utah.

Competency Assessments

Competency — often measured through practical exams or documented case logs — is widely required across Boards to ensure safe application of the technique in clinical settings. 

Patient Consent, Documentation & Billing

Regulations in several jurisdictions (i.e., Colorado, Nevada and Louisiana) require informed consent forms and thorough documentation of treatment plans and outcomes as part of the legal and ethical use of dry needling. It is always best practice to check your payer policies and/or company policies for documentation and reimbursement requirements.

For a complete list of state requirements with links to each practice act, statute, ruling or guideline, please visit our Resources page.

Why This Matters for Practicing Clinicians

Scope Compliance

If a state practice act explicitly includes dry needling within physical therapy scope, PTs are better safeguarded legally — assuming they also comply with required training and record-keeping. 

Risk Management

In states where dry needling is prohibited or ambiguous, practicing clinicians risk regulatory complaints, fines, or disciplinary action if they perform dry needling without proper authority. 

Professional Liability

Documentation of training, competency, consent, and informed clinical decision-making is essential in both permitted and silent states to mitigate malpractice or board issues.

Final Thoughts

The landscape for dry needling in physical therapy is dynamic and reflects broader debates about scope, public safety, and professional boundaries. While most states now permit physical therapists to perform dry needling — often with structured training requirements — a handful still prohibit it, and several remain silent. 

If you’re a PT, or other clinician, considering dry needling:

1. Review your State Practice Act and Board Regulations closely.

2. Fulfill all training and competency requirements before offering the service.

3. Maintain excellent informed consent and documentation practices.

4. Consult your state Board, legal or regulatory counsel when in doubt.

This evolving patchwork of regulation underscores the importance of staying up-to-date — the rules today may not be the rules tomorrow.