Selling a physical therapy or rehab practice
Outpatient PT, OT, speech and pediatric therapy practices sell on referrals, payer mix and therapists who stay. I’ve owned and sold a business that billed insurers and the VA, so I know how reimbursement shapes a buyer’s offer.
- Licensed care owner six years running a senior care business before selling it
- More than 1,000 employees employed by that care business
- Paid at closing no fee unless your practice sells
Platforms keep buying clinics. They pay most for therapist teams that stay.
Deal flow in outpatient rehab has held steady for three years, and the largest operators are changing hands. Reimbursement is stable for now, and the real constraint is clinicians.
LevinPro HC counted 49 rehabilitation acquisitions in 2025 and 47 in 2024. By April 21, 2026 it had logged 13 more. Private equity backed buyers made 60% of the deals announced in the first half of 2025.
Sources: LevinPro HC, Intune Physical Therapy third acquisition of 2026, Apr 2026, LevinPro HC, notable rehabilitation transactions of 2025, Jul 2025
Select Medical agreed to a $3.9 billion take private in March 2026, with 1,917 outpatient rehab clinics. ATI Physical Therapy went private in August 2025. Livingstone expects 2026 to bring the next wave of sponsor exits.
Sources: Becker's Hospital Review, Select Medical going private in $3.9B deal, Mar 2026, ATI Physical Therapy, ATI goes private, Aug 2025, Livingstone Partners, Physical Therapy Tracker, May 2026
APTA estimates physical therapists gained 1.75% on average under the final 2026 fee schedule. For 2027, CMS proposes a 1.68% conversion factor cut, though APTA estimates therapy codes still rise 1% to 3%. Outpatient therapy by telehealth stopped being reimbursed on October 1, 2025.
Sources: APTA, CMS finalizes fee schedule pay bump for the first time in 5 years, Nov 2025, APTA, proposed 2027 Medicare physician fee schedule, Jul 2026, MedBridge, 2026 Medicare physician fee schedule final rule summary, Nov 2025
BLS projections show physical therapist jobs growing 12% from 2025 to 2035, from 283,700 to 317,600. That means about 13,400 openings a year to fill. A buyer pays for a clinic that can hire and keep its staff.
Source: O*NET OnLine, physical therapists national employment trends (BLS projections 2025 to 2035)
What a therapy practice buyer checks first.
National platforms and clinicians buying a first clinic make similar early requests. I collect these therapy files before a practice is marketed.
Visit volume and trend
Patient visits by month, by clinic and by therapist for at least three years. Buyers look for steady growth, not one strong quarter.
Payer mix
Revenue split across commercial, Medicare, Medicaid, workers' comp, auto and cash pay. CT Acquisitions reports commercial plans pay 40% to 90% more per visit than Medicare.
Net revenue per visit
What you actually collect per visit after contractual adjustments and denials, by payer. Buyers compare it to their own contracts.
Therapist productivity
Visits per therapist per day, units billed per visit and the share of visits seen by assistants. This shows how much capacity is left.
Cancellations and plan of care completion
No show and cancellation rates, and how many patients finish their plan of care. High dropout signals scheduling or retention problems.
Referral sources
New patient referrals by physician, practice, school or direct access. Buyers discount a clinic that depends on one surgeon or one school district.
What raises or lowers a clinic's price
| What pushes your price down | What pushes your price up |
|---|---|
| Heavy Medicare and Medicaid volume | A strong share of commercial, workers' comp and cash pay patients |
| The owner treats a full caseload and holds the referral relationships | A clinic director and senior therapists who see patients and keep referrers loyal |
| One surgeon or one school district sends most new patients | Referrals spread across many physicians, schools and direct access patients |
| Open therapist positions and high turnover | A stable team with tenure, a hiring pipeline and clear productivity pay |
| Aging receivables, rising denials and thin documentation | Clean billing, low denials and audit ready charts |
| A single clinic in a market a platform already covers | Several clinics that give a buyer a new metro area or new state |
Platforms, partners and clinicians are all buying.
Sponsor backed platforms lead on add on acquisitions. Partnership buyers like USPH buy a majority and leave owners a stake. Clinicians with SBA loans buy many single clinic practices.
| Buyer type | What they pay for | Active examples |
|---|---|---|
| Private equity backed PT platformsFinancial and strategic | Clinic groups that add density or a new market, with a team that stays. Many keep the local brand. | Ivy Rehab (Waud Capital), Confluent Health (Partners Group), PT Solutions (General Atlantic), H2 Health (Grant Avenue Capital) |
| Partnership buyersStrategic | A majority stake in established groups, with owners keeping 33% to 50% and continuing to run the clinics. | U.S. Physical Therapy |
| Regional operatorsStrategic | Nearby practices that extend their footprint, often entering a new state with one acquisition. | Highbar Physical Therapy, Intune Physical Therapy (Highland Ventures) |
| Pediatric and multispecialty platformsFinancial and strategic | Pediatric PT, OT, speech and autism services with school, early intervention or Medicaid relationships. | Stepping Stones Group (Leonard Green), JoyBridge (Frontline Healthcare Partners), ACES (General Atlantic), Sidekick Therapy Partners |
Recent therapy practice deals.
Clinic deals announced in 2025 and 2026. Most single clinic sales stay private, so this shows which platforms are adding practices.
| Date | Buyer | Target | Type | Value |
|---|---|---|---|---|
| Jul 2026 | U.S. Physical Therapy | Twelve clinic physical therapy practiceAbout $12M revenue and 112,000 visits a year; USPH bought 67%, owners kept 33%; adds a 45th state | Partnership | Undisclosed |
| Apr 2026 | Intune Physical Therapy (Highland Ventures) | Nesin Physical TherapyGreater Huntsville, Alabama; four clinics; Intune's entry into Alabama | Strategic | Undisclosed |
| Apr 2026 | H2 Health (Grant Avenue Capital) | Advanced Physical TherapyLittle Rock, Arkansas; six locations; a new market for H2 | Platform add on | Undisclosed |
| Apr 2026 | Sidekick Therapy Partners | Word of Mouth Clinical AssociatesBrentwood, Tennessee; speech therapy clinic with about 10 SLPs | Strategic | Undisclosed |
Show all 15 deals
| Date | Buyer | Target | Type | Value |
|---|---|---|---|---|
| Mar 2026 | Founders and Welsh, Carson, Anderson & Stowe | Select Medical1,917 outpatient rehab clinics plus other businesses; $16.50 per share | Take private | $3.9B enterprise value |
| Jan 2026 | Ivy Rehab (Waud Capital Partners) | Advance Orthopedic and Sports TherapyTewksbury, Massachusetts; orthopedic, spine, sports and pelvic health | Platform add on | Undisclosed |
| Jan 2026 | ACES (General Atlantic) | Ally Pediatric TherapyPhoenix, Arizona; nine locations; in house speech and OT to be phased out | Platform add on | Undisclosed |
| Jan 2026 | U.S. Physical Therapy | Eight clinic PT management services companyAbout $8M revenue and 66,000 visits a year; USPH bought 50% | Partnership | Undisclosed |
| Nov 2025 | JoyBridge (Frontline Healthcare Partners) | Pediatric Advanced TherapyNorth Carolina; 11 locations; PT, OT, speech and ABA | Platform add on | Undisclosed |
| Nov 2025 | Highbar Physical Therapy | Physical Therapy UThree Massachusetts clinics; therapist owned; keeps its name | Strategic | Undisclosed |
| Oct 2025 | Confluent Health (Partners Group) | Commonwealth Hand and Physical TherapyKentucky; six clinics; keeps its local brand | Platform add on | Undisclosed |
| Aug 2025 | Knighthead and Marathon led holder group | ATI Physical TherapyHundreds of clinics nationwide; minority holders paid $2.85 per share | Take private | Undisclosed |
| Mar 2025 | U.S. Physical Therapy | Three location physical therapy practiceWyoming; about $4.3M revenue and 23,000 visits a year; USPH bought 65% | Partnership | Undisclosed |
| Mar 2025 | The Stepping Stones Group (Leonard Green) | Gallagher Pediatric TherapyFullerton, California; school, home and community OT and PT in Los Angeles and Orange counties | Platform add on | Undisclosed |
| Jan 2025 | PT Solutions (General Atlantic) | OrthoCarolina physical therapy business24 locations, mostly Charlotte; almost 300 physical therapists | Carve out | Undisclosed |
What is your therapy practice worth?
Most single clinic practices are priced on seller's discretionary earnings (SDE). Multi clinic groups with a clinic director in each location are priced on adjusted EBITDA, usually after a quality of earnings review.
Illustrative only, not a valuation.
Published ranges for this industry
- Medical practices sold from 2021 to 2025, a group that includes physical therapy: median 2.05x SDE, upper quartile 2.94x (BizBuySell)
- Physical therapy practices, 2025 to mid 2026: 3.0x to 5.0x SDE under $500K, 4.5x to 6.5x at $500K to $1M (CT Acquisitions)
- PT groups, 2025 to mid 2026: 5.5x to 8x EBITDA at $1M to $3M, 7.5x to 10.5x at $3M to $10M, 10x to 14x above (CT Acquisitions)
- Physical therapy add on acquisitions, 2021 to 2026: about 7.8x EBITDA; platforms under $200M about 12.3x (Livingstone Partners)
Bands start from the therapy multiples above. Payer mix, your role, referrals and staffing shift them by amounts I chose. Use it as a first look.
Where therapy practice owners lose money in a sale.
Clinics of every size stumble on the same issues. With a year or two of lead time, most therapy owners can fix them.
Being the clinic's best therapist
If patients ask for you and surgeons refer to you by name, the buyer is buying your caseload. Building a lead therapist and clinic director fixes that.
Cost: A lower multiple, a longer earnout or a larger rollover
Leaving billing problems in place
Old receivables, high denials and thin notes surface in the quality of earnings review. Buyers then cut earnings or hold back cash.
Cost: A price cut or escrow late in diligence
Assuming therapy payer contracts move with the clinic
Some contracts and credentialing do not move with a sale. Gaps can stop cash flow for months after closing.
Cost: Lost revenue and a nervous buyer
Letting the team hear it secondhand
Therapists who learn of a sale from rumor start interviewing. A buyer prices every resignation into the deal.
Cost: Lost staff and a weaker price
Selling on revenue instead of earnings
Buyers pay a multiple of normalized earnings, not of collections. Owner pay, family on payroll and one time costs need clean add backs.
Cost: Clinic earnings left out of the multiple
Signing the first platform letter
An unsolicited offer sets the buyer's terms, not the market's. Rollover, earnout and employment terms matter as much as price.
Cost: Value left on the table
What therapy practice owners ask me before they sell.
Who is buying physical therapy practices right now?
Sponsor backed platforms like Ivy Rehab, Confluent Health, PT Solutions and H2 Health are buying clinic groups. U.S. Physical Therapy buys majority stakes and leaves owners a share. Regional operators like Highbar and Intune buy nearby practices.
What multiple will my practice sell for?
Small practices usually sell on SDE. BizBuySell reports medical practices at a 2.05x median SDE multiple, while CT Acquisitions publishes 3x to 5x SDE for PT practices under $500K. Larger groups trade on EBITDA, with CT reporting 5.5x to 8x at $1M to $3M.
How many therapy practices are selling each year?
LevinPro HC counted 49 rehabilitation acquisitions in 2025 and 47 in 2024. It logged 13 in 2026 by April 21. Many smaller sales are never announced, so the real number is higher.
Does my Medicare share hurt my value?
It can. CT Acquisitions reports commercial plans pay 40% to 90% more per visit than Medicare. Practices heavy in Medicare and Medicaid trade at the low end of their range. Workers' comp often pays more than commercial.
Is Medicare reimbursement still getting cut?
Not in 2026. APTA estimates physical therapists gained 1.75% on average, the first increase in five years. For 2027, CMS proposes a 1.68% conversion factor cut, but APTA estimates therapy codes still rise 1% to 3%.
Will I have to keep working after I sell?
Often, yes, at least for a while. Partnership buyers like USPH have bought 50% to 67% stakes and kept owners running the clinics. Full buyouts usually include a transition period, so we negotiate its length up front.
Can a therapy buyer use an SBA loan to buy my practice?
In many cases. Since June 2025, an SBA buyer of a clinic must bring at least 10% equity. Your seller note, if on full standby, can supply up to half.
Are pediatric, OT and speech practices valued differently?
CT Acquisitions describes pediatric and other specialty practices as earning a premium over general orthopedic clinics. SovDoc cites 7x to 12x EBITDA for pediatric platforms above $1M of EBITDA. Smaller pediatric practices are priced closer to general ranges.
Terms buyers will use
- SDE
- Clinic profit plus owner pay, perks and one time costs. Single clinics earning under a few million are usually valued on it.
- Adjusted EBITDA
- Clinic earnings before interest, taxes, depreciation and amortization, with one time items removed and a market wage for the owner's clinical and admin work.
- Payer mix
- The share of revenue from commercial insurance, Medicare, Medicaid, workers' comp, auto and cash pay patients.
- Net revenue per visit
- The amount actually collected per patient visit after contractual adjustments and denials.
- Visits per therapist per day
- A productivity measure that shows how much capacity each clinician has left.
- Plan of care
- The treatment plan a therapist sets for a patient, including goals, frequency and number of visits.
- Direct access
- A patient seeing a physical therapist without a physician referral, within the limits of state law and payer rules.
- Credentialing
- Enrolling each therapist and location with insurers so their visits can be billed.
- Quality of earnings
- An accounting review a buyer orders to test that reported earnings are real and repeatable.
- Platform
- The first therapy group a private equity sponsor buys, which then adds clinics.
- Add on
- A smaller practice bought by a platform to add clinics, density or a new market.
- Rollover equity
- A share of the business the seller keeps or reinvests, paid out when the buyer later sells.
- Management services organization
- A company that runs the business side of clinics, such as billing and staffing, often used where state rules limit ownership.
- Full standby
- A seller note with no payments of any kind until the SBA loan is repaid.
Own a physical therapy or rehab practice? Schedule a complimentary call with Max!
Twenty confidential minutes. I will look at your payer mix, team and referral sources as a buyer would and point out what to fix.
Sources (25)
- LevinPro HC, notable rehabilitation transactions of 2025, Jul 2025
- LevinPro HC, Intune Physical Therapy third acquisition of 2026, Apr 2026
- LevinPro HC, H2 Health acquires Advanced Physical Therapy, Apr 2026
- LevinPro HC, Ivy Rehab first acquisition of 2026, Jan 2026
- Livingstone Partners, Physical Therapy Tracker, May 2026
- Becker's Hospital Review, Select Medical going private in $3.9B deal, Mar 2026
- Pulse 2.0, Select Medical $3.9 billion take private, Mar 2026
- ATI Physical Therapy, ATI goes private, Aug 2025
- APTA, CMS finalizes fee schedule pay bump for the first time in 5 years, Nov 2025
- APTA, proposed 2027 Medicare physician fee schedule, Jul 2026
- MedBridge, 2026 Medicare physician fee schedule final rule summary, Nov 2025
- O*NET OnLine, physical therapists national employment trends (BLS projections 2025 to 2035)
- CT Acquisitions, physical therapy practice M&A multiples report 2026
- BizBuySell, medical practice valuation benchmarks
- SovDoc, how to value a pediatric physical therapy practice, Jun 2025
- Live Oak Bank, SBA SOP 50 10 8 changes, effective Jun 2025
- Business Wire, U.S. Physical Therapy acquires a twelve clinic practice, Jul 2026
- Business Wire, U.S. Physical Therapy acquires an eight clinic management services company, Jan 2026
- LevinPro HC, Sidekick Therapy Partners expands in Tennessee, Apr 2026
- Behavioral Health Business, ACES acquires Ally Pediatric Therapy, Jan 2026
- LevinPro HC, JoyBridge Kids acquires Pediatric Advanced Therapy, Nov 2025
- LevinPro HC, Physical Therapy U joins Highbar Physical Therapy, Nov 2025
- LevinPro HC, Confluent Health and Commonwealth Hand and Physical Therapy, Oct 2025
- Behavioral Health Business, Stepping Stones Group acquires Gallagher Pediatric Therapy, Mar 2025
- North Carolina Health News, OrthoCarolina to sell its physical therapy business, Jan 2025
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