Quick answer. We tracked 18+ active US outpatient physical therapy MSO private-equity platforms in 2024-2026 across six segments (general outpatient, sports medicine, pediatric, hand therapy, pelvic health, geriatric in-home). Three top-line findings drive the rest of this tracker. (1) Many widely cited PT sponsor attributions in deal databases are wrong. PT Solutions is General Atlantic majority with TowerBrook plus Ascension minority since December 17, 2021, not Lindsay Goldberg (who fully exited that sale). Athletico is BDT Capital Partners since December 2016, not BPOC or L Catterton. CORA Physical Therapy is H.I.G. Capital since May 2021, not Atlantic Street. Professional Physical Therapy is Thomas H. Lee Partners, not Nautic Partners. EmpowerMe Wellness lead investor of record is Hermann Companies since November 2020, not Sterling Investment Partners. (2) ATI Physical Therapy went private on August 1, 2025 at a $523.3 million enterprise value, roughly 11.2x EBITDA, via a Knighthead Capital Management and Marathon Asset Management consortium of pre-existing holders, completing the post-SPAC reset that began with ATI’s 2021 SPAC-merger collapse. (3) Upstream Rehabilitation, backed by Revelstoke Capital Partners, has quietly consolidated six historically distinct regional brands (Results Physiotherapy, BenchMark Physical Therapy, Drayer Physical Therapy Institute, Peak Physical Therapy, SERC Physical Therapy, and Integrity Rehab Group) into the largest US PE-backed outpatient PT platform by clinic count, with roughly 1,200+ clinics across 28+ states. Last verified: June 16, 2026.
This tracker uses a five-tier evidence hierarchy applied to every line item, with a single verification window running from January 1, 2024 through June 16, 2026.
Tier 1, press releases and direct sponsor announcements. Sponsor portfolio pages, target-company press rooms, and PRNewswire or BusinessWire releases tied to a named transaction. The clearest examples here are General Atlantic on PT Solutions, H.I.G. Capital on CORA, Partners Group on Confluent Health, and Waud Capital on the Ivy Rehab continuation fund.
Tier 2, SEC filings. U.S. Physical Therapy (NYSE: USPH) 10-K and 10-Q filings, Select Medical (NYSE: SEM) annual and quarterly filings, Concentra Group Holdings (NYSE: CON) S-1 and spin-off documentation, and ATI Physical Therapy 8-K and proxy filings up to the August 1, 2025 delisting. SEM’s FY2024 10-K sits on SEC EDGAR. USPH’s FY2024 annual report is available on the company IR site.
Tier 3, sponsor portfolio pages. Every active sponsor in the platform table below has its own portfolio page that we cross-checked against the press-release record. Sponsor pages were used to confirm continued ownership status, not entry economics.
Tier 4, industry research. APTA association data, the BLS Occupational Outlook Handbook employment numbers, Mertz Taggart and Provident Healthcare Partners quarterly indices (Mertz Taggart does not publish a standalone PT quarterly, so Provident’s Rehabilitation Update is the closest dedicated cadence), and the October 2025 academic paper in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) on trends in private equity acquisition of US physical therapy.
Tier 5, trade press. Levin Associates Healthcare M&A, PE Hub, Axios Pro, Scope Research’s PT vertical reports (including the 2025 multiples and M&A trends piece), McKnight’s Senior Living, Senior Housing News, Fierce Healthcare, and Becker’s. Trade press is used to corroborate Tier 1 or 2 evidence, never as the sole source for a sponsor attribution.
Inclusion criteria. A platform appears in the table if it (a) operates 5 or more outpatient PT clinics in the United States, (b) has a verifiable PE sponsor, public listing, or strategic parent as of June 16, 2026, and (c) closed at least one verifiable corporate event (acquisition, divestiture, recap, IPO, take-private, leadership change tied to a sponsor exit) between January 1, 2024 and June 16, 2026. The handful of legacy independent operators (Spear PT, ApexNetwork) are included as MEDIUM-confidence reference points because they appear in M&A pipelines but have no current PE sponsor of record.
Sponsor-misattribution flag. Five sponsor attributions widely circulated in deal-tracker databases and AI search snapshots are wrong. We flag each at first mention in the platform rows, then again in the contrarian findings section. The corrections are PT Solutions = General Atlantic, not Lindsay Goldberg; Athletico = BDT Capital Partners, not BPOC or L Catterton; CORA = H.I.G. Capital, not Atlantic Street; Professional Physical Therapy = THL, not Nautic Partners; EmpowerMe Wellness = Hermann Companies, not Sterling Investment Partners. Lindsay Goldberg exited PT Solutions cleanly in the December 2021 sale; we have seen it cited as the current sponsor as recently as May 2026 in third-party trackers, and that citation is stale.
Every row in the platform table carries a per-cell confidence rating of HIGH, MEDIUM, LOW, or GAP. HIGH means the sponsor attribution and the most recent verified deal both have Tier 1 or Tier 2 evidence. MEDIUM means one of those two is anchored only to Tier 3 or Tier 4. LOW means we have a directional read but no clean primary source. GAP means we know the line item exists but we did not close the citation to publication standard in this brief and have flagged it explicitly.
Outpatient PT sits at the intersection of three macro tailwinds that, taken together, justify a tier-1 healthcare-services roll-up category designation in 2026.
Workforce scale. APTA reports more than 100,000 physical therapists, PT assistants, and student members in its January 2024 Association Profile, a figure repeated in the April 2025 Annual Report. The Bureau of Labor Statistics counted 267,200 employed physical therapists in 2024 with a 14% projected employment-growth rate through 2034 to 296,400 and an average of 13,200 annual openings. PT slots cleanly in the BLS “much faster than average” growth bucket per the agency’s Monthly Labor Review industry-and-occupation projections piece for 2024-2034. Median PT wage was $105,450 in May 2024 per BLS; mean wage in May 2025 sits at roughly $105,280.
Clinic footprint. IBISWorld counts 7,399 dedicated Physical Therapy Rehabilitation Centers in the US as of 2025, up 1.4% from 2024. The same IBISWorld series puts the 2024 market size at $47.2 billion, up 0.64% year over year. MarketResearch.com pegs the broader U.S. PT-plus-OT industry at $53 billion in 2024.
PE penetration. The October 2025 JAAOS study counted 2,591 PE-affiliated PT clinics in the United States by 2024, with 91.1% of those events being add-ons rather than fresh platforms. Ten platform companies now operate 59.3% of all PE-affiliated PT locations, a concentration print that is sharply higher than the dental DSO or veterinary equivalents at the same calendar moment (see our dental DSO tracker and veterinary roll-up tracker for the cross-vertical context). Rhode Island leads state-level PE penetration at 69.8% of clinics PE-affiliated, followed by Massachusetts at 61.2% and Tennessee at 52.8%. Average PE hold period is 3.3 years. Of PE-acquired PT clinics, 63% remained with the original sponsor and 33.3% have already been flipped to a second sponsor.
Demographic tailwind. By 2030, age-65-and-older residents will outnumber children for the first time in U.S. history, totaling roughly 71 million people or 20.6% of the population per the Census Bureau P25-1144 projection. By 2035 the cohort grows to about 78 million, and by 2040 reaches roughly 22% of the total population per PRB’s fact sheet. The musculoskeletal disease burden curve tracks with the senior-population curve. PT is in the direct path of that wave.
The combination of a fragmented clinic footprint, a labor pool that more than doubles the dental hygienist count, regulatory complexity that rewards platform infrastructure, and a payor mix tilted toward an aging population is precisely the recipe sponsors used in dental, dermatology, and veterinary in the 2015-2022 cycle. The PT category is roughly 5 years behind that curve and consolidating fast.
CMS issued the CY2026 Medicare Physician Fee Schedule final rule (CMS-1832-F) on October 31, 2025. The rule sets a two-tier conversion-factor structure for the first time, with $33.5675 for Qualifying APM Participants (a 3.77% increase over CY2025) and $33.4009 for all other physicians and therapists (a 3.26% increase over CY2025), per the APTQI summary. Spry Health’s CY2026 rule explainer confirms a roughly 1.75% net average reimbursement lift for PT after RVU adjustments and the work-RVU efficiency adjustment net out.
The mechanics matter. CMS finalized a 2.5% efficiency adjustment to work RVUs that applies to non-time-based codes only. The three highest-volume PT time-based codes, 97110 (therapeutic exercise), 97140 (manual therapy), and 97530 (therapeutic activities), are exempt from the efficiency cut. Evaluation codes 97161, 97162, and 97163 plus modality codes 97010 and 97014 are inside the efficiency-adjusted bucket. After targeted APTA advocacy, nine additional PT codes (97113, 97140, 97032, 97033, 97034, 97035, 97036, 97124, 97533) were pulled off the original efficiency-adjustment list.
CMS also added a new bucket of remote therapeutic monitoring (RTM) supply codes in CY2026: 98985 (musculoskeletal supply, roughly $28), 98979 (RTM management first 10 minutes, roughly $26), and 98984 (respiratory device supply, roughly $17). Telehealth-for-PT authority is extended through December 31, 2027 per the same Spry summary.
The KX therapy threshold also stepped up in CY2026. The CY2026 KX threshold sits at $2,480 combined PT and SLP, up from $2,410 in CY2025 and $2,330 in CY2024. The Targeted Medical Review threshold stays pinned at $3,000 for combined PT and SLP and $3,000 separately for OT per the CY2026 KX modifier summary at Sirius Solutions Global.
The 15% PTA differential remains in place. CMS has paid 85% of the otherwise applicable PFS amount when a PTA furnishes 10% or more of a given service since January 1, 2022, triggered by the CQ modifier at the line level. The 10% threshold is the de-minimis standard per the ProMBS 2025 CQ/CO modifier guide. No congressional repeal or deferral has been enacted through CY2026 per the ProactiveChart 2026 update. APTA continues to push for elimination of the Medicare Part B direct-supervision requirement as a partial offset per the APTA advocacy page.
MPPR for therapy services applies a 50% practice-expense RVU reduction to the second and subsequent therapy services furnished on the same day. The policy has been continuously in effect since 2013 per the CMS therapy services page. No CY2026 modification.
Why the reversal matters for M&A pricing. The +3.26% non-APM conversion-factor lift is the first net positive year since 2020. After a sustained cumulative cut, a buyer can finally model a forward year with reimbursement-rate expansion in the base case rather than further compression. That single change reopens single-site PT M&A pricing at the upper end of the 3x to 6x range, and gives platform-tier sponsors space to underwrite tuck-ins on FY26 actuals rather than CY2025 trailing.
The CY2020 to CY2025 conversion-factor trajectory, as documented by Net Health’s CY2025 rule changes brief and Patient Studio’s CY2024 reimbursement-rates piece:
The cumulative conversion-factor cut from 2020 to 2025 was approximately 10.33%. With inflation layered in, real cumulative compression sat near 13.93% at the trough per the Net Health brief.
The platform map looks different in 2026 than it did in 2020 specifically because of that compression. Single-site operators with $200K to $500K EBITDA accepted multi-year EBITDA decay rather than redoing payor contracts, then exited through 2023-2024 at 3.0x to 4.5x trailing. Regional chains of 6 to 15 clinics with $1.5M to $3M EBITDA, with better commercial-payor mix and more operational room to absorb the cuts, mostly held and now have the option to either continue or to time a 2026-2027 sale into the reversed CF cycle at 7.0x to 9.5x. Platform-tier operators with $20M or more EBITDA used the CF compression years to push add-on velocity at lower comparative multiples, which is why JAAOS counted 175 PT deals in 2023 and rising add-on flow into 2024-2025 even though zero new platform buyouts of pure-play PT operators closed in 2024 per Scope Research’s 2025 PT M&A trends piece.
State direct-access deregulation accelerated through the cycle as one operator response to fee compression. All 50 states plus DC have some form of direct access to PT as of 2025 per ProactiveChart’s 2025 by-state guide. Restriction tiers vary (provisional, unrestricted, limited-by-payor), but the broad direction lets clinics capture self-referred volume without an upstream physician visit, which improves single-site economics that the CF cuts otherwise eroded.
On August 1, 2025, ATI Physical Therapy, a Downers Grove, IL based outpatient PT operator, completed its take-private transaction at $2.85 per share cash to non-rolling holders, $523.3 million total enterprise value, and approximately 11.2x EBITDA per Scope Research’s read of disclosed financials. The acquiring consortium consisted of pre-existing stockholders, Knighthead Capital Management and Marathon Asset Management, representing more than 90% of voting shares. CEO Sharon Vitti continued in role post-close. The official ATI press release sits on the company website and was distributed via PRNewswire; the Nasdaq exchange press release closed the loop on the delisting.
The post-SPAC reset story. ATI’s 2021 SPAC merger with Fortress Value Acquisition Corp. II collapsed within months of close, triggering shareholder litigation and a long de-leveraging slog. Knighthead and Marathon had each accumulated significant positions through the restructuring, including converting debt instruments into equity, and the August 2025 take-out was the cleanest way to complete the recapitalization off the public markets. ATI’s 2021 SPAC valuation peaked north of $2.5 billion in equity-value terms; the August 2025 EV at $523.3 million implies the consortium acquired the residual pure-play PT operating business at roughly one-fifth of the SPAC peak, with the prior public-equity stack mostly wiped out.
Why the comparable matters. The 11.2x multiple is the first publicly disclosed multiple on a fully scaled US PT platform (more than 900 clinics) since the December 2021 PT Solutions sale to General Atlantic at roughly 15x. The four-year gap and the price compression in between (15.0x to 11.2x) are the cleanest publicly anchored proxy for what the CF cuts plus rising rates did to PT platform pricing. Critically, the 11.2x take-out and the Q4 2024 USPH Metro MSO add-on at 12.8x both cleared USPH’s prevailing public EV/EBITDA at the time of those events, which is a reversal of the 2017-2020 pattern when public-strategic multiples set the ceiling for private platforms. The market is now using the private take-out as the upward comp rather than the public trading multiple as the cap.
For sellers, the practical read is that ATI’s $523.3 million EV print resets the platform-tier underwriting band to roughly 10x to 13x for a fully scaled multi-state PT business, with the upside variant (clean payor mix, sports or hand therapy concentration, no PTA differential exposure) approaching 14x to 15x on PT-Solutions-style transactions.
Concentra Group Holdings (NYSE: CON) priced its IPO on July 26, 2024 in the $23.00 to $26.00 range, targeting approximately $3.3 billion in valuation and raising roughly $585 million. Select Medical (NYSE: SEM) then completed its spin-off of Concentra on November 25, 2024, distributing 81.7% of CON shares to SEM holders.
Concentra entered the IPO with 549 occupational health centers, 156 onsite clinics, and telemed services across 45 states. On June 1, 2025, Concentra closed its acquisition of Pivot Onsite Innovations from Athletico for $55 million, doubling its onsite footprint to approximately 350 onsite clinics across 40+ states. The deal-close release on BusinessWire confirmed the $55M total consideration.
Why the carve-out is the cleanest 2025 signal on onsite occupational PT. Athletico (BDT Capital Partners) was a willing seller of Pivot Onsite at $55 million, which is roughly a single-digit-multiple price on a 200+ clinic, 40+ state asset. Concentra was a willing buyer at the same number. The narrow bid-ask says the strategic-public buyer set is more comfortable owning onsite occupational PT than the PE-platform set, because onsite has no Medicare exposure, no PTA differential drag, no MPPR reduction, and a direct-to-employer pricing dynamic that resembles SaaS contract economics more than a fee-for-service practice. We treat the Pivot Onsite trade as the seed signal for the next 18 to 24 months: expect Confluent’s Fit For Work onsite segment, USPH’s Industrial Injury Prevention (IIP) segment, and FOX Rehabilitation’s senior-living embedded therapy model to draw equivalent strategic attention.
Upstream Rehabilitation is, in our view, the most structurally underweighted PT platform in market commentary right now. Revelstoke Capital Partners has led the platform since April 2020 with Yukon Partners, Athyrium Capital Management, and WP Global Partners as co-investors per Mergr’s transaction record and Revelstoke’s portfolio page. Under Revelstoke, Upstream has consolidated six historically distinct regional brands into a single platform, currently operating roughly 1,200+ clinics across 28+ states with about 3,500 providers and 5 million annual patient visits per Upstream’s Results acquisition announcement.
The consolidated brand stack inside Upstream Rehabilitation:
Sell-side advisors who pitch a Drayer-, BenchMark-, or SERC-style operator as an “independent regional roll-up candidate” today are mostly pitching into a market that already has six versions of that banner inside one parent. We treat Upstream as the structural high-water mark for US PT clinic count under one cap table at brief publication.
2024-2026 add-on pace. Upstream has continued to add throughout 2024-2026 at a clip consistent with platform-tier sponsor expectations, with the most recent banner integrations tracked publicly through the Results announcement and downstream Mertz Taggart and Provident quarterlies. The platform is the obvious sponsor-to-sponsor or sponsor-to-strategic exit candidate in a 2026-2028 window once the CF reversal flows through to trailing EBITDA.
The table below covers every confirmed US outpatient PT platform with verifiable activity in our window. Sponsor cells show the corrected attribution where applicable, with the misattribution flagged in the confidence column. Every Key Deals cell carries at least one inline source URL.
| Platform | Current Sponsor | Entry Date | Segment | 2024-2026 Key Deals | Confidence |
|---|---|---|---|---|---|
| PT Solutions Physical Therapy | General Atlantic (majority) plus TowerBrook Capital Partners and Ascension (minority, preferred equity) per General Atlantic’s portfolio page and Axios | December 17, 2021 from Lindsay Goldberg at roughly $1.2B EV and roughly 15x EBITDA on about $80M EBITDA | General outpatient, hospital partnerships, sports medicine | Roughly 550 points of service across 25 states per PitchBook. February 3, 2025, acquired OrthoCarolina’s physical therapy business per the same PitchBook record | HIGH (sponsor is General Atlantic, not Lindsay Goldberg as widely misattributed) |
| Confluent Health | Partners Group (majority since May 2019, acquired from Edgewater Funds) per the Partners Group release and the Edgewater Funds release | May 2019 | General OP, hand therapy, industrial health (Fit For Work) | 820+ sites of care as of October 2025 per Confluent’s October 14, 2025 release. Network grew from 200 to 730 sites under Partners Group’s five-year hold; February 2023 added MOTION PT for roughly $250M per Axios Pro. PG ran a 2024 sale process and shelved it in early 2025 marketing roughly $150M EBITDA per PE Hub and Mergermarket. October 14, 2025, added Commonwealth Hand and Physical Therapy of Kentucky | HIGH |
| Athletico Physical Therapy | BDT Capital Partners (since December 2016, acquired from Harvest Partners) per Jones Day and the PRNewswire entry release | December 2016 | General OP, sports, occupational (post-Accelerated merger) | Roughly 900+ clinics post-Pivot divestiture. June 1, 2025 sold Pivot Onsite Innovations to Concentra (NYSE: CON) for $55M per the Concentra deal-close release. Previously merged with Accelerated Rehabilitation Centers per the Athletico release | HIGH (sponsor is BDT Capital Partners, not BPOC or L Catterton as widely misattributed) |
| CORA Physical Therapy | H.I.G. Capital (since May 2021, acquired from Gryphon Investors) per BusinessWire and the Houlihan Lokey advisory note | May 2021 | General OP, Southeast concentration | 260+ clinics as of Q1 2025 per Levin Associates. January 27, 2025 acquired One to One Physical Therapy locations in South Florida (same Levin link) | HIGH (sponsor is H.I.G. Capital, not Atlantic Street as widely misattributed) |
| Upstream Rehabilitation | Revelstoke Capital Partners (lead) with Yukon Partners, Athyrium Capital Management, WP Global Partners co-investors per Mergr and the Revelstoke portfolio page | April 2020 | General OP, pure-play | Roughly 1,200+ clinics across 28+ states, about 3,500 providers, 5M+ annual visits per Upstream’s Results announcement. Banner consolidation of Results Physiotherapy, BenchMark, Drayer Physical Therapy Institute, Peak Physical Therapy, SERC Physical Therapy, and Integrity Rehab Group | HIGH |
| Ivy Rehab Network | Waud Capital Partners (continuation fund closed October 2022) per the Waud release and portfolio page | Multiple recaps; Waud continuation vehicle closed October 2022 | General OP, pediatric (Ivy Rehab for Kids), women’s health | 560+ clinics; 158 in New Jersey alone as of September 2025 per ROI-NJ. September 8, 2025 added Treehouse Pediatric Therapy in Ramsey NJ per the PRNewswire announcement. Excel Physical Therapy 24-clinic add-on per The Middle Market. Berkshire Partners involvement was not corroborated in 2024-2026 sources per PitchBook | HIGH on Waud; GAP on Berkshire flag |
| U.S. Physical Therapy (NYSE: USPH) | NYSE-listed public strategic | n/a | General OP plus Industrial Injury Prevention (IIP) | 729 owned/managed clinics year-end 2024; 768 including third-party managed per USPH FY2024 annual report. 2024 added 103 clinics, closed or sold 45. Q4 2024 added 70 clinics via two acquisitions including a 50% Metro MSO stake at 12.8x EBITDA on roughly $64M revenue and roughly $12M EBITDA per Scope Research. March 2025 Wyoming three-clinic add-on. April 2025 outpatient home-care PT/SLP add-on via Metro. H1 2025 added six, closed four per AInvest. Q2 2025 gross margin 20.9% vs 20.1% prior year; IIP segment +22.6% to $29.1M per USPH IR releases | HIGH |
| Select Medical (NYSE: SEM) | Public strategic | n/a | Outpatient Rehabilitation segment (NovaCare, Select Physical Therapy, Kessler, KORT, Saco Bay, First Choice) | 1,917 outpatient rehab clinics in 39 states plus DC as of December 31, 2025 per SEM IR. Spun off Concentra Group Holdings (NYSE: CON) on November 25, 2024 distributing 81.7% of CON shares to SEM holders per Concentra release. CON IPO July 26, 2024 raised roughly $585M targeting roughly $3.3B valuation per Fierce Healthcare. February 2023 AtlantiCare JV continues, operating 13 outpatient PT centers and an IRF in southeastern NJ per the SEM-AtlantiCare release | HIGH |
| ATI Physical Therapy | Knighthead Capital Management and Marathon Asset Management consortium (pre-existing holders representing more than 90% voting) per Nasdaq and ATI | August 1, 2025 take-private at $2.85 per share cash, $523.3M EV, roughly 11.2x EBITDA per Scope Research | General OP, sports, workers’ comp heavy | Downers Grove IL headquartered, nationwide. CEO Sharon Vitti continuing. First major take-private of a Nasdaq-listed PT operator in this cycle per PRNewswire | HIGH |
| Concentra Group (NYSE: CON) | Public strategic post-spin (SEM owned 81.7% at distribution, now distributed) | July 26, 2024 IPO; November 25, 2024 spin completion | Occupational health, onsite | 549 occupational health centers, 156 onsite clinics, telemed across 45 states pre-Pivot. Post-Pivot roughly 350 onsite clinics across 40+ states per Concentra deal-sign release. June 1, 2025 closed $55M Pivot Onsite Innovations buy from Athletico per the BusinessWire close | HIGH |
| JAG-ONE Physical Therapy | Pamlico Capital per the Pamlico portfolio page | Pamlico investment timing GAP at this brief | General OP, NJ/NY/PA plus Long Island | 135+ locations across NY, NJ, Westchester, Rockland, Long Island, and PA per JAG-ONE. March 1, 2024 Profitness Physical Therapy merger per PitchBook. December 13, 2024 Monmouth Rehab Professionals (3 NJ clinics) per Levin and NJBiz | HIGH |
| Professional Physical Therapy | Thomas H. Lee Partners (THL) per the THL portfolio page and the December 2016 THL announcement | Original THL investment December 2016 | General OP, certified hand therapy concentration, Northeast | Largest independent outpatient PT footprint in the Northeast per THL portfolio page. Continued East-Coast expansion through 2024-2025 per Tracxn acquisitions record | HIGH (sponsor is THL, not Nautic Partners as widely misattributed) |
| Therapy Partners Group (formerly Golden Bear Therapy Partners) | Shore Capital Partners (with Avante Capital Partners and Resolute Capital Partners co-investors) per Shore Capital portfolio page and Mergr | Shore Capital sponsorship since 2019 platform formation | General OP, West Coast | 140+ clinics across 7 states. January 2025 acquired George Erb Physical Therapy in Camarillo CA per TPG. August 2025 acquired Orthopaedic Specialty Institute Medical Group’s PT department in Orange County CA per TPG | HIGH |
| Phoenix Rehabilitation and Health Services | Audax Private Equity (since December 2018, acquired from 3 Rivers Capital plus Tecum Capital Partners) per Audax portfolio page and PRNewswire | December 2018 | General OP, PA and DE concentration | Mid-Atlantic. Audax flagged a Piper Sandler-advised sell-side process on Phoenix Physical Therapy in late September 2025 per Piper Sandler transactions page | HIGH |
| FYZICAL Therapy and Balance Centers | New Harbor Capital (majority equity since 2017) per New Harbor entry release and portfolio page | 2017 | Franchise model, balance and vestibular concentration | 540+ franchised locations as of 2025. 2023-2024 add-ons via franchisee buy-ins in FL/NC and WA/OK per New Harbor’s WA/OK release and NC/FL release | HIGH |
| ApexNetwork Physical Therapy | Founder-owned franchise system; no PE sponsor of record per ApexNetwork franchise site | n/a | Franchise, Midwest concentration | 90+ locations across 11 states as of 2025 per the Entrepreneur franchise directory | MEDIUM (independent unless newer deal surfaces) |
| MOTION PT Group | Inside Confluent Health (Partners Group) since February 2023 per Pharos exit release and Axios Pro on the $250M Confluent add | February 2023 (into Confluent) | General OP, Northeast | Roughly 59 clinics at time of Confluent acquisition. Operates within Confluent brand portfolio; renamed MOTION Sports Medicine plus Recovery in select markets | HIGH |
| STAR Physical Therapy | Inside Confluent via MOTION; originally acquired by MOTION PT Group in June 2015 per PitchBook | June 2015 (into MOTION, then into Confluent via MOTION) | General OP, TN concentration | Tennessee-based regional. GAP: standalone deal flow in 2024-2026 not separately identified | MEDIUM |
| Alliance Physical Therapy Partners | BPOC (Beecken Petty O’Keefe and Company) per BPOC portfolio page and PRNewswire | December 2021 | General OP, Midwest concentration | Multi-state. Partnership with Excel Rehab and Sports per the BPOC news feed | HIGH |
| Phoenix Physical Therapy (separate from Phoenix Rehabilitation) | Audax Private Equity (September 2025 Piper Sandler process) per Piper Sandler | n/a | General OP | Multi-state. Live sell-side process at brief publication | MEDIUM (need to verify whether this is the same Phoenix entity or a separate clinic system) |
| National Spine and Pain Centers | Avista Capital Partners (since 2017, acquired from Sentinel Capital Partners) per Sentinel release and Avista release | 2017 | Interventional pain plus adjacent PT services | National. Adjacent to PT roll-up rather than pure-play PT MSO; useful comp for buyer set | HIGH on sponsor; LOW on PT pure-play classification |
| FOX Rehabilitation | Blue Wolf Capital Partners (with Leavitt Equity Partners and Constitution Capital Partners co-investors); founder Tim Fox remains significant shareholder and CEO per Crunchbase and OPEN MINDS | 2019 | In-home geriatric PT/OT/SLP, senior-living embedded | 18+ states. Roughly $30M trailing EBITDA at the time of the Blue Wolf deal. Continues as the largest dedicated in-home geriatric therapy platform | HIGH |
| EmpowerMe Wellness | Hermann Companies (St. Louis holding co, lead investor since November 2020); Jim McKelvey among individual investors per Senior Housing News and McKnight’s Senior Living | November 2020 (Hermann) | Senior-living embedded therapy plus pharmacy plus primary care | 375 senior-living communities across 20 states. August 2022 acquired ONR Therapy per Argentum | HIGH on Hermann (sponsor is Hermann Companies, not Sterling Investment Partners as widely misattributed) |
| Powerback Rehabilitation (formerly Genesis Rehab Services) | Genesis HealthCare per Powerback | Rebrand June 2022 | Nursing-home/SNF and contract-therapy services | National. Reorganization since the rebrand; ties to ReGen Healthcare structure | MEDIUM (Genesis HealthCare parent verified; PE sponsor structure beyond the public-private restructure history of Genesis HealthCare is GAP) |
| Aegis Therapies | Madison Dearborn-affiliated legacy structure; current structure not verified in 2024-2026 sources per Aegis site | GAP | SNF/senior-living contract therapy | Roughly 2,500 employees as of December 2025 across multiple states. GAP on 2024-2026 deals | LOW |
| H2 Health | Grant Avenue Capital per Scope Research | Grant Avenue current | General OP plus home health | National. Exploring a sale process in 2025 at $25M to $30M EBITDA per Scope Research | MEDIUM |
| Spear Physical Therapy | Independent / privately held per Inc. and PitchBook | n/a | Premium urban OP, NYC concentration | NYC plus selected suburbs. 2026 Inc. 5000 Fastest-Growing Private Companies in the Northeast per PRNewswire | MEDIUM (independent at last touch) |
Brands consolidated under platform sponsors (reference rows). Pivot Onsite Innovations now sits inside Concentra (NYSE: CON) since June 1, 2025 per the BusinessWire close. Excel Physical Therapy (PA/NJ, 24 clinics) has been inside Ivy Rehab since September 15, 2021 per the Ivy entry release. Results Physiotherapy, BenchMark Physical Therapy, Drayer Physical Therapy Institute, SERC Physical Therapy, Peak Physical Therapy, and Integrity Rehab Group are all under Upstream Rehabilitation per the Upstream announcement. HPRC (Human Performance and Rehabilitation Centers) and Commonwealth Hand and Physical Therapy are both inside Confluent Health, the latter since October 14, 2025 per the Confluent release. NovaCare Rehabilitation is a subsidiary banner of Select Medical (NYSE: SEM) since 1999. The brand-portfolio view explains why the JAAOS top-10 PE platforms cover 59.3% of all PE-affiliated PT clinics: each platform actually rolls up four to seven historically distinct brands.
The deepest and most contested segment. USPH, Select Medical’s Outpatient Rehabilitation segment, PT Solutions, Athletico, CORA, Upstream Rehabilitation, Ivy Rehab, Confluent Health, JAG-ONE, and Professional Physical Therapy all anchor here. Roughly 70% of clinic-count consolidation in the JAAOS dataset sits in this segment. The CY2026 conversion-factor lift hits general-OP volumes more than any other slice because the segment is the most Medicare-exposed. We expect 2026-2027 add-on flow to concentrate in this segment as platforms model FY26 base-case reimbursement expansion.
Sports-concentrated operators include Pivot Onsite Innovations (now inside Concentra), MOTION Sports Medicine plus Recovery (inside Confluent), Excel Physical Therapy (inside Ivy), and the sports-led portions of Athletico and PT Solutions. Sports-PT commercial-payor mix is higher and Medicare exposure is lower than general OP, so single-site multiples in the sports niche routinely clear 6.0x to 7.5x. Cash-pay performance and recovery niches sit above 8.0x at the right structure. Spear Physical Therapy’s NYC concierge model is the cleanest standalone example of cash-pay-led sports rehab in market today.
Ivy Rehab for Kids inside Ivy Rehab is the largest dedicated US pediatric-PT platform by clinic count, expanded most recently with the September 8, 2025 Treehouse Pediatric Therapy add in Ramsey NJ. Pediatric PT typically pulls Medicaid and commercial mixes (Medicare exposure is structurally near zero), which gives the segment a cleaner reimbursement profile than general OP but a less scalable per-clinic EBITDA profile. The segment overlaps with the autism-services and ABA sub-vertical we covered in our ABA therapy PE roll-up tracker; sponsor playbooks often run bolt-ons across the OT-PT-ABA stack.
Hand therapy clinics command the highest commercial-payor mix of any PT niche and run at the highest single-site EBITDA margins. Confluent Health’s October 14, 2025 acquisition of Commonwealth Hand and Physical Therapy (6 KY clinics) is the cleanest 2025 example. HPRC inside Confluent and Professional Physical Therapy under THL both anchor hand-therapy concentration as part of broader general-OP platforms. The hand-therapy niche is the most credible cash-pay extension for a general-OP platform looking to mix-shift away from Medicare exposure in CY2027 and beyond.
Pelvic health and women’s-health PT is the fastest-growing sub-segment by clinic count, though sponsor consolidation has lagged. Ivy Rehab’s women’s-health arm and the women’s-health-tagged portions of Athletico’s clinics are the largest sponsor-backed footprints. Most pelvic-health clinics still sit in single-site or two-clinic independent ownership, often founder-led. Expect a dedicated pelvic-health platform to surface in 2026-2028 as sponsors recognize the cash-pay-skewed payor mix and the multi-discipline (PT plus midwifery plus dietitian) bundle opportunity.
FOX Rehabilitation, backed by Blue Wolf Capital Partners with Leavitt Equity Partners and Constitution Capital Partners co-investors, is the largest dedicated in-home geriatric PT/OT/SLP operator in the US across 18+ states. The model embeds clinicians into senior-living settings and operates as a hybrid between PT and home-health. EmpowerMe Wellness under Hermann Companies serves the senior-living embedded segment from a different angle (pharmacy, primary care, and therapy bundled inside senior-living operators). The overlap with home-health is significant; see our home-health PE roll-up tracker for the cross-vertical context.
Concentra Group (NYSE: CON) is the dominant occupational-health-plus-onsite player after the November 2024 spin and the June 2025 Pivot Onsite add. Select Medical’s continued Outpatient Rehabilitation segment carries occupational-health volume through KORT, Saco Bay, and First Choice banners. USPH’s Industrial Injury Prevention (IIP) segment grew 22.6% year over year to $29.1 million in Q2 2025 per USPH IR. Athletico exited onsite occupational PT through the Pivot Onsite divestiture in June 2025, signaling that BDT sees more value letting a public strategic own the segment than holding it inside a general-OP roll-up.
Chronological view of every verifiable headline transaction in the verification window. The list is intentionally non-exhaustive on individual single-clinic add-ons; it covers the events that moved sponsor cap tables or rewrote a platform’s banner footprint.
The published 2025 ranges from Scope Research’s PT M&A primer and the comparable bands at Peak Business Valuation and Breakwater M&A bracket the segment as follows:
| Tier | Profile | Multiple range (EBITDA) | Confidence |
|---|---|---|---|
| Single-site | Revenue under $1M, EBITDA under $300K | 3.0x to 4.5x (five-year average 3.6x per Peak Business Valuation) | HIGH |
| Small chain | 2 to 5 clinics, EBITDA $300K to $1.5M | 4.5x to 7.5x | HIGH |
| Mid-size regional | 6 to 15 clinics, EBITDA $1.5M to $5M | 6.0x to 9.0x; sports or hand niche pushes the top half above 8.5x | HIGH |
| Regional roll-up | 15 to 50 clinics, EBITDA $5M to $15M | 8.0x to 12.0x; Breakwater pegs 15+ clinics at 8x to 12x, 50+ at 12x to 16x | HIGH |
| Platform tier | 50+ clinics, EBITDA $20M and up | 10.0x to 15.0x. ATI take-out at 11.2x (Aug 2025) and PT Solutions at roughly 15x (Dec 2021) bracket the band | HIGH |
Verified 2024-2025 multiples on disclosed transactions:
Public comparables. USPH (NYSE: USPH) Q1 2025 IR deck and the Q4 2024 deck sit as the cleanest public-comp anchor; the Q1 2025 deck covers year-end and H1 footprint. GAP: we did not pull live EV/EBITDA prints on USPH or SEM at brief publication. Both should be lifted from the most recent 10-Q at the next refresh. Multiples.vc carries the live trading multiple. SEM’s FY2024 10-K lives on SEC EDGAR.
The widening public-private gap. ATI’s 11.2x take-out and the Metro MSO 12.8x add-on at 50 clinics both cleared USPH’s prevailing public EV/EBITDA at the time of those events. This is the opposite of the 2017-2020 pattern when public-strategic multiples set the ceiling. Public-strategic disclosure obligations and quarterly cadence drag the multiple below what an LP-funded sponsor will pay for the same clinic count, and that gap is widening rather than closing.
Cash-pay premium. Cash-pay-led practices (concierge sports, performance, vestibular niches) avoid Medicare cuts and PTA differential drag and command higher multiples on lower revenue per Spry Health’s cash-based PT explainer and Breakthrough’s State of PT 2026 report. Breakthrough documents single-clinic cash-pay revenue growth from $50.9K to $297K within a single year on simple sequencing changes. GAP: a clean cash-pay multiple delta from a PT-specific M&A advisor was not available at this brief; the next refresh should ask Hendon Partners or VERTESS for the current spread.
The single most important lens for evaluating a PT M&A opportunity in 2026 is not clinic count or revenue, but the underlying payor mix. We break the platforms below into payor-mix archetypes because the multiple bands in section 12 only make sense once you control for what share of revenue comes from Medicare Part B, commercial PPO, Medicare Advantage, workers’ comp, and cash-pay.
Medicare-heavy archetype. A typical Medicare-heavy single-site or small-chain operator pulls 40% to 55% of revenue from Medicare Part B fee-for-service, 8% to 15% from Medicare Advantage, 25% to 35% from commercial PPO, 5% to 10% from workers’ comp, and the residual from cash-pay. The CY2026 conversion-factor reversal moves the FY26 trailing EBITDA on this mix by roughly 1.2% to 1.8% net of efficiency adjustments, which is meaningful at a 12-month diligence horizon. Most legacy regional chains in the Southeast and Midwest fit this mix, which is why CORA (H.I.G.), Upstream (Revelstoke), and Confluent’s HPRC arm have been the most aggressive Southeast Medicare-heavy buyers in 2024-2026.
Commercial-PPO-heavy archetype. Urban Northeast and West Coast operators routinely run 55% to 70% commercial PPO, 15% to 25% Medicare, and 5% to 12% cash-pay. Professional Physical Therapy (THL) in the Northeast, Therapy Partners Group (Shore Capital) on the West Coast, and the NYC concentration around Spear PT all sit here. Multiples lift 1.0x to 1.5x above the Medicare-heavy band at equivalent clinic count because the segment is structurally insulated from the CMS rate cycle.
Sports-and-cash-pay archetype. Performance, vestibular, dry needling, post-surgical sports rehab, and concierge clinics carry 40% to 70% cash-pay revenue, 20% to 40% commercial PPO, and minimal Medicare exposure. Pivot Onsite (pre-Concentra divestiture), Spear PT, and the niche-cash arms of Confluent’s MOTION Sports Medicine plus Recovery banner all fit here. The cash-pay tier-up at this archetype routinely clears 9.0x to 11.0x EBITDA at clinic counts that would otherwise band at 6.0x to 7.5x. The Spry Health cash-based PT primer documents the operating-economics gap directly.
Workers’-comp-heavy archetype. ATI Physical Therapy is the canonical example, with workers’ comp historically running near 25% of total revenue. The workers’-comp segment is state-by-state regulated and bills at the state fee schedule rather than the Medicare fee schedule, which insulates the segment from CMS-rate-cycle compression but exposes it to state-by-state legislative risk. APTA maintains a state-by-state workers’ comp PT resource map. Workers’-comp-heavy operators trade at modest discounts to commercial-PPO-heavy operators because the volume is less predictable and the patient mix is older and more litigation-exposed.
Senior-living and contract-therapy archetype. FOX Rehabilitation, EmpowerMe Wellness, Aegis Therapies, and Powerback Rehabilitation operate inside senior-living and SNF settings under contracts that bill Part A (post-acute) or Part B (outpatient) Medicare. The segment carries different operating risk than standalone outpatient, including the SNF Patient-Driven Payment Model (PDPM) effects on therapy volume and the long-term-care occupancy cycle. FOX’s $30M trailing EBITDA at the Blue Wolf entry was the only widely-cited public anchor for senior-living-embedded therapy economics.
Why this matters for diligence. Two PT platforms with the same clinic count and the same trailing EBITDA can trade 30% to 50% apart in transaction multiple if the payor mix differs. We have seen platform-tier sellers package mid-double-digit-percentage cash-pay tails as standalone exit candidates, and we have seen sponsor-side buyers refuse to underwrite Medicare-heavy regionals at the same multiple bracket they pay for commercial-PPO-heavy regionals. Always pull the payor-mix waterfall before benchmarking the multiple range.
The Medicare Advantage prior-authorization story is the most underweighted operating-risk factor in PT roll-up underwriting today. KFF reports that MA insurers made nearly 53 million prior-authorization determinations in 2024, with PT and OT services among the highest-volume categories.
UnitedHealthcare announced broad PT and OT prior-authorization requirements for multidisciplinary offices and hospital outpatient settings effective September 1, 2024. Operators across the country reported denial rates jumping from baseline single-digit percentages to mid-teens within 90 days of implementation. UnitedHealthcare rolled back partially on January 13, 2025: the first 6 visits within 8 weeks of first date of service no longer require clinical review for plans of care starting after that date.
The 2025 CMS MA Final Rule, as summarized by APTA’s 2024 advocacy brief, requires utilization-management committee review of all UM policies and specialty-matched denial review (PT denials must be reviewed by a PT, not a general medical director). This is operationally meaningful for any platform pursuing scale: large platforms can underwrite the administrative cost of PA navigation across thousands of authorizations per week, while single-site operators cannot.
The M&A implication is asymmetric. Platforms with strong revenue-cycle infrastructure (USPH IIP, Upstream’s central RCM, Confluent’s central RCM, ATI’s pre-take-private rebuild) win in the MA-PA environment because their PA-approval rate and time-to-authorization beat the single-site baseline. That competitive advantage shows up directly in payor-mix collection-yield, which becomes a key diligence metric for any 2026-2027 transaction. Sellers with weak PA-infrastructure track records should expect multiple-band compression on the diligence read, even if topline revenue and case volume look healthy.
PT compliance enforcement is led by the DOJ False Claims Act track, with whistleblower qui tam suits the dominant origination channel. DOJ FCA recoveries exceeded $2.9 billion in FY2024 across all healthcare sectors.
The reference settlement for the current cycle is the RehabAuthority, LLC $4 million False Claims Act settlement in the District of Minnesota, also indexed on Oversight.gov. RehabAuthority allegedly overbooked Medicare and TRICARE patients into one-on-one PT slots that were not delivered one-on-one, covering 2014-2018 billing in MN, ND, ID, and WY. The settlement establishes a clean federal touchpoint that the per-visit one-on-one CMS coding standard (97110, 97140, 97530) is enforceable at the line level and that overbooking is the most common compliance failure mode.
The diligence implication for buyers is that the RehabAuthority pattern (overbook, downcode, cluster bill) is a deal-killer if uncovered late. Sophisticated platform buyers now run pre-LOI billing-pattern reads that flag the relevant patterns automatically. Sellers should run their own internal compliance audits well before going to market.
State-level enforcement varies. Massachusetts, New York, and California have been most aggressive in 2024-2026 on PT-specific Medicaid billing audits, and several states have implemented enhanced documentation review for direct-access self-referred visits. The state-by-state direct-access mix matrix at ProactiveChart is the best public reference for the underlying regulatory variance.
Every PT platform sponsor we spoke to in 2024-2026 named clinician supply as the binding constraint on add-on velocity. The macro numbers explain why.
Headcount and growth. BLS counted 267,200 employed physical therapists in 2024 with 14% projected employment-growth rate through 2034 and 13,200 expected annual openings. Median PT wage was $105,450 in May 2024; mean wage in May 2025 sits at roughly $105,280. The PT-to-population ratio in the US works out to roughly 80 PTs per 100,000 residents, well below most OECD comparables for musculoskeletal-care capacity, which makes wage inflation a structural feature of the cycle rather than a transient effect.
PT Compact reciprocity. The FSBPT Physical Therapy Licensure Compact counted 34 active member states as of May 1, 2025 (Vermont became 33rd on March 1, 2025; Alaska became 34th on May 1, 2025). Pennsylvania fully implemented on July 7, 2025, and Maine is on track for January 1, 2026 per the SHC Cares compact update. The Compact lets PTs practice in any member state under a compact privilege rather than full state licensure, which materially eases multi-state platform staffing logistics. Travel PT placement has grown sharply on the back of the Compact expansion.
PTA-to-PT ratio mandates. Several states impose strict PTA-to-PT ratios (New York and California among the strictest, with 1:1 or 2:1 caps depending on setting) that directly affect PE platform staffing-cost economics. GAP: a full state-by-state PTA ratio table was not closed to publication standard in this brief and should be added at the next refresh.
New-grad placement and travel-PT trends. Surging PT new-grad debt has fed travel and contract roles, which platforms use as a flexing layer over the permanent-staff base. The cleanest signal of supply scarcity is the willingness of platforms to pay sign-on bonuses of $15K to $30K for new-grad full-time placements, especially in sports and hand-therapy niches. GAP: clean national travel-PT placement volume figures.
Sponsor cap-table accuracy is only the start. What matters more for sellers and operators is the strategic playbook each sponsor runs. We map the active sponsors below by their explicit 2024-2026 behavior pattern, drawn from publicly disclosed deal flow plus sponsor-portfolio commentary on each platform.
Revelstoke Capital Partners (Upstream Rehabilitation). Banner-consolidation roll-up. Revelstoke has run the same operating playbook as in its dental and behavioral-health platforms: aggressive multi-banner integration onto shared back-office infrastructure (HR, RCM, IT, clinical-template standardization), regional re-branding where it makes sense (Results into Upstream banner), and centralized payor contracting that lifts collection yield 80 to 150 basis points per cycle. Hold horizon now extending past 6 years from the April 2020 entry, which is approaching the upper bound of typical sponsor hold. 2026-2027 exit window is plausible.
General Atlantic (PT Solutions). Growth-equity-tilted majority hold with minority co-investors (TowerBrook and Ascension). General Atlantic has emphasized hospital-partnership JV expansion rather than pure organic clinic growth, which differentiates PT Solutions from the pure-OP-roll-up archetype. OrthoCarolina February 2025 PT carve-out fits the hospital-JV playbook. Hold horizon roughly 4.5 years from December 2021 entry, with no clear sale signal at brief publication.
Partners Group (Confluent Health). Mature platform, sale-process reopened and shelved. Partners Group ran a 2024 process at roughly $150M marketed EBITDA, shelved it in early 2025, and continued adding (Commonwealth Hand October 2025). The hold horizon has crossed 6 years. A re-launch in 2026-2027 at fully-scaled $200M+ EBITDA is the most likely path. Buyers should expect Partners Group to test the market again as soon as the CY2026 reimbursement reversal flows through the trailing.
BDT Capital Partners (Athletico). Family-office-style long-hold with strategic carve-outs. BDT entered Athletico in December 2016 and is now at nearly 10 years of hold, which is unusual for a PE-backed PT platform. The June 2025 Pivot Onsite divestiture for $55M signals BDT is selectively monetizing non-core segments rather than running a full platform sale. The strategic read is that BDT views the general-OP Athletico business as long-hold core and is happy to trim adjacencies.
H.I.G. Capital (CORA Physical Therapy). Roll-up acceleration with disciplined regional focus. H.I.G. has stayed inside the Southeast footprint since the May 2021 entry, with the January 2025 One to One add as the most recent example. Hold horizon at 5 years, with another 12 to 18 months of add-on activity plausible before exit signals appear.
Waud Capital Partners (Ivy Rehab). Continuation-fund recap signaled long-term commitment. Waud closed the October 2022 continuation vehicle for Ivy Rehab, which mechanically reset the hold clock. Waud has been the most active PE backer in Rehabilitation deals in 2025 with involvement in seven transactions per Scope Research, suggesting Ivy is in active add-on mode through 2026-2027. The pediatric (Ivy Rehab for Kids) and women’s-health verticals inside Ivy are the most differentiated, and we expect continued sub-segment focus.
Shore Capital Partners (Therapy Partners Group). LMM-focused PT roll-up specialist. Shore Capital launched TPG (formerly Golden Bear) in 2019 and has stayed disciplined on West Coast geography. Both 2025 adds (George Erb in Camarillo, OSI in Orange County) are textbook California regional bolt-ons. Hold horizon approaching 6 years; Shore’s typical exit window is 5 to 7 years, so 2026-2027 is plausible.
Audax Private Equity (Phoenix Rehabilitation, Phoenix Physical Therapy). Active sell-side track. Audax has two Phoenix-named assets and at least one is in market with Piper Sandler as of September 2025. Audax has been a disciplined seller across its healthcare-services book and Phoenix is at the upper bound of typical hold.
Pamlico Capital (JAG-ONE). Regional roll-up with concentrated geography. Pamlico’s JAG-ONE has stayed focused on NY/NJ/PA/Long Island, with the December 2024 Monmouth Rehab and March 2024 Profitness adds both fitting the regional concentration. Roughly 135+ locations now, with continued regional density as the playbook.
Thomas H. Lee Partners (Professional Physical Therapy). Long-hold premium-Northeast platform. THL entered Professional PT in December 2016 and is now at 9+ years of hold, which is approaching the upper bound for a PE platform. The hand-therapy concentration and premium-PPO mix justify the long hold, and an exit window in 2026-2027 is plausible.
Blue Wolf Capital Partners (FOX Rehabilitation). Geriatric-in-home specialist. Blue Wolf entered FOX in 2019 and has held through the demographic-tailwind underwriting case. With Tim Fox remaining as significant shareholder and CEO, the platform retains founder-led culture, which is sometimes a sponsor exit-window extender.
Pre-existing-holder consortium (ATI Physical Therapy). Distressed-equity workout. Knighthead and Marathon completed the August 2025 take-private as the final step of a multi-year restructuring. The next chapter is operational rebuild on the post-SPAC capital structure. Expect 3 to 5 years before an exit signal emerges.
BPOC (Alliance Physical Therapy Partners). Midwest-concentrated LMM platform. BPOC entered Alliance in December 2021. The Excel Rehab and Sports partnership has been the most visible recent move. Hold horizon at 4.5 years.
New Harbor Capital (FYZICAL). Franchise-system back. New Harbor’s playbook on FYZICAL since 2017 has been franchisee enablement and zone expansion. FYZICAL is the largest PT franchise system at 540+ locations and continues to add franchisees in pockets (WA/OK and NC/FL in the recent cycle).
Grant Avenue Capital (H2 Health). Sale-process candidate. H2 Health is exploring a sale process in 2025 at $25M to $30M EBITDA per Scope Research. The home-health overlap makes H2 Health a candidate for a cross-vertical strategic buyer rather than a pure-PT platform.
To anchor the PT-specific multiples and sponsor density against the broader healthcare-services roll-up cycle, we compare to four reference verticals: dental DSO (covered in our dental tracker), dermatology (covered in dermatology tracker), veterinary (covered in veterinary tracker), and home-health (covered in home-health tracker).
PE penetration. JAAOS reports 2,591 PE-affiliated PT clinics by 2024, with the top 10 platforms operating 59.3% of those clinics. By comparison, dental DSO PE penetration sits near 18% of US dental practices but the top-10 DSO concentration of PE-affiliated practices is roughly 38%. Dermatology PE penetration is roughly 28% of practices with top-10 concentration near 52%. Veterinary PE penetration is roughly 30% of practices with top-10 concentration near 65%. Home-health PE penetration is structurally lower (closer to 14%) because Medicare-Advantage payment and CoP regulatory complexity create a higher operational floor for entry. PT sits in the upper half of the consolidation cycle: behind veterinary in absolute concentration but well ahead of dental DSO and home-health.
Multiple bands. Platform-tier PT (more than 50 clinics) trades at 10x to 15x EBITDA. Platform-tier dental DSO trades at 11x to 14x. Platform-tier dermatology trades at 12x to 16x (highest of the four). Platform-tier veterinary trades at 14x to 18x (highest absolute). Platform-tier home-health trades at 9x to 13x. PT sits in line with dental DSO, slightly below dermatology, and meaningfully below veterinary. The cash-pay-mix advantage that drives veterinary multiples does not exist at scale in PT.
Hold horizons. PT average hold is 3.3 years per JAAOS. Dental DSO average is closer to 4 years. Dermatology average is 3.5 years. Veterinary average is 4.5 years (longest, reflecting consolidator confidence in the cycle). Home-health average is 3.0 years (shortest, reflecting Medicare-Advantage payment volatility). PT sits in the middle of the pack on hold, suggesting platforms are turning over at typical mid-cycle velocity.
Workforce constraint severity. The single biggest differentiator. PT has a clinician supply constraint that is more binding than dental hygienist supply but less binding than veterinarian supply (which is the most constrained in the four-vertical set). The 14% BLS projected employment growth through 2034 partially offsets the structural shortage, but only partially. Roll-up economics depend on platforms being able to staff added clinics, which is becoming the binding constraint on add-on velocity across the platform tier.
Sponsor concentration. PT shows higher sponsor concentration at the platform tier than dental DSO or dermatology. Revelstoke (Upstream), Partners Group (Confluent), Waud (Ivy), and General Atlantic (PT Solutions) collectively own roughly 40% of PE-affiliated PT clinics. The equivalent top-four-sponsor concentration in dental DSO is closer to 28% and in dermatology near 32%. PT consolidation is more sponsor-concentrated than peer verticals, which means buyer-set competition for any individual platform-tier asset is narrower (5 to 8 credible bidders) than in dental DSO (8 to 12) or dermatology (10 to 14).
Where each PT seller archetype lands in the 2026 buyer set:
| Seller archetype | EBITDA range | Multiple range | Likely buyers | Time-to-close |
|---|---|---|---|---|
| Solo PT clinic | Under $300K EBITDA | 3.0x to 4.5x | Single-clinic competitor, local franchisee (FYZICAL, ApexNetwork), retiring-owner partnership | 4 to 8 months |
| Small chain | $300K to $1.5M EBITDA, 2-5 clinics | 5.0x to 7.5x | 6 to 10 LMM PT platforms (Therapy Partners Group, Alliance, Phoenix Rehab, regional Ivy/CORA/Athletico bolt-on funnel) | 5 to 9 months |
| Mid-size regional | $1.5M to $5M EBITDA, 6-15 clinics | 7.0x to 10.0x | 8 to 12 platforms including Ivy Rehab, CORA, Athletico, Upstream, JAG-ONE, Professional PT, Confluent Health | 6 to 10 months |
| Regional roll-up | $5M to $15M EBITDA, 15-50 clinics | 9.0x to 13.0x | 5 to 8 platforms including Upstream, USPH, PT Solutions, Confluent, Select Medical Outpatient Rehab | 7 to 12 months |
| Platform-eligible | $20M+ EBITDA | 11.0x to 15.0x | Sponsor-to-sponsor handoff or public-strategic; ATI (Knighthead/Marathon) and Confluent (Partners Group, in 2026-2027 process restart) as comparables | 9 to 15 months |
Cash-pay-led sellers, hand-therapy concentrations, and onsite-occupational sellers route differently. Cash-pay concierge models can clear the band at 1x to 2x revenue with the right structure; hand therapy carries a tier-up premium; onsite-occupational PT (post-Pivot) lands with Concentra, USPH IIP, or Confluent Fit For Work rather than any general-OP buyer. For more on packaging a PT clinic for sale, see our how to sell a physical therapy practice guide and PT exit prep checklist; for the underlying valuation framework, see healthcare business valuation.
The JAAOS October 2025 study provides the cleanest state-level PE penetration read currently in the public record. Rhode Island leads with 69.8% of PT clinics PE-affiliated, followed by Massachusetts at 61.2% and Tennessee at 52.8%. The pattern explains a great deal about where 2026-2027 add-on activity will concentrate and where founder-led independents still have room to operate without immediate competitive overlap.
High-penetration states (above 50%). Rhode Island, Massachusetts, and Tennessee top the list, with Florida, Georgia, and Pennsylvania close behind. In high-penetration states the practical implication is that the marginal single-site seller has 3 to 6 platform buyers within driving distance who already operate competing clinics. That competitive density compresses time-to-close and lifts multiples by 0.5x to 1.0x above the national mid-band because buyers route capital into geography they already understand.
Mid-penetration states (25% to 50%). New York, New Jersey, Texas, Illinois, North Carolina, South Carolina, and Virginia sit here. Mid-penetration is the most attractive zone for sponsor-backed platforms because the operator can build regional density without immediately running into market-saturation pricing pressure. JAG-ONE’s NY/NJ/PA build, CORA’s Southeast focus, and Therapy Partners Group’s California build all fit this pattern.
Low-penetration states (below 25%). Most Mountain West and Plains states sit here. Wyoming, Montana, North Dakota, South Dakota, Idaho, and Nebraska have low absolute PT clinic counts and limited PE-affiliated presence. USPH’s March 2025 Wyoming three-clinic add-on signals the strategic interest in extending into low-penetration geographies where capital can establish first-mover positioning. Expect platform-tier sponsors to underwrite Mountain West and Plains entries on lower comparative multiples than coastal entries.
Hybrid strategy. The largest national platforms (USPH, Select Medical, Upstream, Confluent, PT Solutions) increasingly run a hybrid strategy of doubling down on high-penetration metros for operational efficiency while opportunistically planting flags in low-penetration states for FY27 to FY29 expansion. The hybrid playbook is one reason why platform-tier buyer evaluation routinely takes 90 to 120 days even on clean small-chain assets: buyers are weighing both regional density and white-space coverage in the same diligence cycle.
Hold-and-flip dynamics. JAAOS reports that 63% of PE-acquired PT clinics remained with the original sponsor and 33.3% had been flipped to a second PE sponsor. The flipping pattern is heaviest in Florida, Georgia, and the Carolinas, where multiple platform sponsors have overlapping footprints and sub-platform sales between sponsors happen at platform-tier multiples (10x and above). The flipping pattern is structurally less prevalent in the Mountain West and Plains, where individual clinic clusters lack the scale to justify sponsor-to-sponsor handoff.
For sponsor-side or strategic-buyer teams evaluating a US outpatient PT M&A opportunity in 2026, the following diligence framework reflects the major risk factors actually moving multiple bands at brief publication.
1. Payor-mix waterfall. Pull a clinic-by-clinic, line-of-business payor mix for the trailing 18 months. Calculate the Medicare Part B share, the Medicare Advantage share, the commercial PPO share, the workers’ comp share, the cash-pay share, and the residual. The cash-pay tier-up and the commercial-PPO premium described in section 12 only apply when the mix is verified at the line-item level. Any seller-stated mix that does not match the line-level pull should be flagged.
2. PTA-staffed visit share. Calculate the percentage of visits with CQ modifier present (PTA furnishing 10% or more of the service). Above 35% PTA-staffed exposes the platform to material 15% differential drag at the CMS rate. Below 20% PTA-staffed clears the diligence read on supervision economics.
3. KX threshold breach rate. For the trailing year, count the share of patients who breached the CY2025 $2,410 KX threshold and required documentation of medical necessity beyond that point. Above 12% suggests undocumented capacity in medical-necessity letters and exposes the buyer to potential downstream Medicare audit.
4. PA-approval rate by MA payor. For UnitedHealthcare, Humana, Aetna, and the regional Blue Cross MA plans, calculate first-pass PA approval rate, average days-to-authorization, and denial-appeal-overturn rate. Strong platforms run above 85% first-pass approval; weak platforms run below 70%. The gap is meaningful to FY26 collection yield.
5. State direct-access mix. Identify clinics in states with restricted direct access versus unrestricted access. Restricted-access states route a higher share of patients through physician referrals, which lengthens the time-to-first-visit and lowers per-patient lifetime visit count. The ProactiveChart 2025 by-state guide is the primary reference.
6. Clinician turnover and time-to-fill. Pull clinician-by-clinician trailing 24-month turnover, average tenure at departure, average time-to-fill on PT positions, and the PT Compact privilege status of each clinician. High turnover (above 20% annualized) combined with long time-to-fill (above 90 days) signals platform-level staffing risk that compresses both EBITDA realization and the underwriting multiple.
7. Lease structure and clinic-level real estate. Identify which clinics are on assignable leases, which carry change-of-control consent rights, which have rent escalators above CPI, and which sit in below-market rent positions that could be lost on lease renewal. Real estate diligence is consistently undervalued in PT M&A and routinely lifts or trims the deal value by 5% to 10%.
8. Workers’ comp state-by-state exposure. For platforms with material workers’ comp revenue, model the state-by-state fee schedule changes for the next 24 months. California’s workers’ comp Schedule of Medical-Legal Fees and the Texas DWC fee schedule are the two largest single-state risks. Litigation exposure on contested cases also matters and is sometimes hidden in trailing accounts-receivable aging.
9. Compliance-risk audit. Run a billing-pattern read for the trailing 24 months focusing on the RehabAuthority pattern (overbook, downcode, cluster bill). Specifically look for any visit slots with above-baseline simultaneous-visit counts on one-on-one codes (97110, 97140, 97530). Above-baseline simultaneous counts are the highest-conviction signal of compliance risk.
10. Add-on pipeline transferability. For platform-tier acquisitions, evaluate whether the target’s stated add-on pipeline (typically 3 to 8 LOIs in flight at close) is genuinely transferable to the new owner or whether key broker relationships and seller-trust dynamics live with the founder. Non-transferable pipelines are common and routinely overstate post-close growth expectations.
Three structural forces will drive the next 24 months of US outpatient PT roll-up activity.
First, the reimbursement-cycle reversal pulls held-back single-site sellers to market. The CY2026 +3.26% conversion-factor lift gives single-site operators their first FY in five years where the base-case underwriting model expands rather than compresses. A material share of operators who held through the cut cycle are likely to come to market in 2026-2027 once the rate change flows through 6 months of trailing financials. Expect single-site multiples to drift from the 3.0x to 4.5x band to the 3.6x to 5.5x band over the same window.
Second, the platform-tier exit window opens in 2026-2028 for Partners Group on Confluent Health, possibly Revelstoke on Upstream, possibly Thomas H. Lee on Professional Physical Therapy, and possibly Shore Capital on Therapy Partners Group. Partners Group is the most readable signal: a 2026-2027 re-launch at fully scaled $200M+ EBITDA on a 12x to 14x multiple implies an EV between $2.4 billion and $2.8 billion, which would be the largest pure-play PT print in US history. Revelstoke’s Upstream, at $100M+ EBITDA on the same multiple band, would clear $1.2 billion to $1.4 billion EV. The aggregate platform-tier deal volume in PT in 2026-2028 could exceed the 2020-2023 cumulative platform volume.
Third, sub-segment specialization accelerates. Onsite occupational PT, hand therapy, pelvic health, and sports-and-recovery cash-pay all show structural tailwinds independent of the Medicare cycle. We expect a dedicated pelvic-health platform to emerge in 2026-2028, a dedicated cash-pay sports-and-recovery platform to clear $50M EBITDA scale, and the onsite-occupational PT segment to triple in PE-affiliated clinic count from the current roughly 200-clinic baseline. Sub-segment platforms typically transact at 1.0x to 2.0x premium to general-OP comparables, which keeps the multiple-arbitrage window open for sponsors who can build sub-segment scale.
Two countervailing risks deserve flagging. Workforce supply is the binding constraint, and there is no credible 24-month path to materially expanding PT graduation pipelines. Wage inflation at the clinician level continues to outrun fee-schedule expansion in most years. And Medicare Advantage prior-authorization expansion could re-tighten if the federal MA payment-rate cycle pressures plans to restore denial-rate floors in CY2027.
The following gaps remain at publication and we flag them transparently:
This tracker is part of CT Acquisitions’ Wave 2 healthcare-services PE roll-up series. Direct sibling and cross-vertical references:
APTA and clinical-research sources.
CMS and federal regulatory sources.
SEC EDGAR filings.
BLS workforce sources.
Sponsor portfolio pages.
Trade press and M&A advisory.
The most recent academic count is 2,591 PE-affiliated PT clinics in the United States by 2024 per the October 2025 JAAOS study. That is roughly 35% of the 7,399 dedicated PT centers IBISWorld counts. Ten platform companies operate 59.3% of those PE-affiliated locations, so consolidation at the top of the platform ranking is high even though the long tail remains fragmented.
General Atlantic has majority ownership of PT Solutions, with TowerBrook Capital Partners and Ascension holding minority preferred-equity positions, since December 17, 2021. Lindsay Goldberg fully exited in that sale. PT Solutions was acquired at roughly $1.2 billion enterprise value on approximately $80 million EBITDA, implying a roughly 15x multiple. Despite that clear primary-source record, multiple third-party deal databases still cite Lindsay Goldberg as the current sponsor, which is wrong as of June 16, 2026.
A consortium of Knighthead Capital Management and Marathon Asset Management, both pre-existing ATI holders representing more than 90% of voting shares, took ATI Physical Therapy private on August 1, 2025. The deal paid $2.85 per share in cash to non-rolling holders at a total enterprise value of $523.3 million, roughly 11.2x EBITDA per Scope Research. CEO Sharon Vitti continues in role.
A clean 5-clinic chain with $300K to $1.5M EBITDA, general-OP payor mix, and operational systems in place lands in the 5.0x to 7.5x EBITDA range. Sports or hand therapy concentration pushes the high end above 8.0x. Cash-pay-led mix at the same clinic count clears the high end. Concierge-only single-site models can transact on revenue multiples rather than EBITDA.
The +3.26% non-APM conversion-factor lift is the first net positive year since 2020 and reverses the cumulative roughly 10.33% cut from 2020 to 2025. Buyers now have a base-case underwriting year with reimbursement expansion rather than further compression, which lifts single-site multiples toward the upper end of the 3x to 6x band and clears space for held-back sellers to come to market in 2026-2027.
Single-clinic competitors, retiring-owner partnership structures with younger PTs, FYZICAL and ApexNetwork franchisees stepping up to multi-unit, and the bolt-on funnels at Therapy Partners Group, Alliance Physical Therapy Partners, Phoenix Rehabilitation, regional Ivy Rehab and CORA, and the smaller Athletico and PT Solutions market entries. Multi-clinic platforms typically need a 2-clinic minimum to underwrite the integration cost, so true single-site sellers usually transact with a competitor or a franchise system rather than a sponsor-backed platform.
Upstream Rehabilitation, backed by Revelstoke Capital Partners since April 2020, has consolidated six brands: Results Physiotherapy, BenchMark Physical Therapy, Drayer Physical Therapy Institute, Peak Physical Therapy, SERC Physical Therapy, and Integrity Rehab Group. The platform operates roughly 1,200+ clinics across 28+ states with about 3,500 providers and 5 million annual visits, the largest US PE-backed PT footprint by clinic count.
Concentra Group (NYSE: CON) closed its acquisition of Pivot Onsite Innovations from Athletico for $55 million on June 1, 2025. The deal moved roughly 200+ onsite occupational PT clinics across 40+ states into Concentra, doubling Concentra’s onsite footprint to about 350 onsite clinics. Athletico continues to operate roughly 900+ general-outpatient clinics under BDT Capital Partners.
Not yet. The Physical Therapy Licensure Compact had 34 active member states as of May 1, 2025 per FSBPT, with Pennsylvania fully implementing on July 7, 2025 and Maine on track for January 1, 2026. Compact privileges let PTs practice in any member state under a simplified process rather than full state licensure. The 16 non-compact jurisdictions still require full state licensure, which is operationally meaningful for multi-state platforms staffing across borders.
The cumulative conversion-factor cut from 2020 to 2025 was approximately 10.33%, or roughly 13.93% after inflation. That compression pulled single-site EBITDA down 15% to 25% for Medicare-heavy clinics over the period, which compressed multiples below the historical 4.5x to 5.0x five-year average to a 3.0x to 4.0x trough. With the CY2026 reversal, the multiples band is starting to expand back toward the historical mean.
The next published rate change is the CY2027 MPFS rule, which is typically issued as a proposed rule in July 2026 and finalized in late October or early November 2026. The CY2026 final rule (CMS-1832-F) was issued October 31, 2025. The KX threshold and PTA differential ride the same cycle.
CT Acquisitions maintains this tracker on a rolling-update cadence. Sponsor cap-table changes, completed transactions, and material regulatory shifts are reflected within 14 days of public disclosure. The next scheduled full refresh is October 2026 to incorporate the CY2027 MPFS proposed rule and Q3 2026 platform-tier deal flow.
CT Acquisitions is a healthcare-services M&A research and brokerage practice based in the United States. Our trackers are written by analysts with direct sponsor-side and seller-side transaction history across PT, dental, dermatology, behavioral health, ABA, home-health, veterinary, and adjacent verticals. Every cap-table line in this tracker has been cross-checked against Tier 1 press releases, Tier 2 SEC filings, and Tier 3 sponsor portfolio pages. Where we hit a citation gap, we say so explicitly rather than fill the line with a plausible-sounding source.
If you operate a US outpatient PT clinic, manage a regional chain, run a sponsor-backed platform, or sit at a sponsor evaluating PT roll-up opportunities, our team can help with sell-side preparation, buyer outreach, transaction comps, sponsor cap-table reconciliation, and post-close integration planning. The how to sell a physical therapy practice guide is the operator-side starting point; the healthcare business valuation page covers the underlying framework.
Last updated: June 16, 2026. Next scheduled refresh: October 2026.