I submitted one comment already, but another point I feel is important is the ability of the PT to determine the benefit and appropriate use of dry needling without a physician referral.  A PT trained in this technique knows when it is appropriate to use and when it is not appropriate to use.  Virginia is a state where a patient may access a PT directly; that is important to me.  I do not have the time or the money to see my physician first and basically just tell them that I want a referral to PT to have dry needling performed.  This technique is safe to be performed by a qualified, trained PT without being directed by a physician.