Offices of Physical, Occupational and Speech Therapists, and Audiologists (NAICS 62134)

A Histometrics industry-level primer for public- and private-market investors

1. Overview

This is the outpatient rehabilitation industry: the neighborhood physical-therapy (PT) clinic that rehabs a torn knee or a post-surgery shoulder, plus the occupational-therapy (OT) practice that helps a stroke patient re-learn daily tasks, the speech-language pathology (SLP) office that treats a child's stutter or an adult's swallowing disorder, and the audiology office that tests hearing and fits hearing aids. In the North American Industry Classification System (NAICS), these four professions share one code because they share one business model: licensed clinicians treating patients in office-based clinics and billing insurers per visit.[1]

At this level (the 5-digit NAICS industry 62134), there is only one more-detailed industry beneath it — the 6-digit national industry 621340 — so this page is effectively identical to that child. It exists to give investors the rollup figures for the level and then hand off to the child for full detail.

Why it matters to an investor: it is a large, growing, and unusually fragmented slice of U.S. health care — durable demand from an aging population sitting on top of a sea of small owner-operated practices. That mix has made it a classic "roll-up" target and, more recently, a cautionary tale about leverage meeting falling reimbursement.

2. What's inside — and why this level equals its one child

The 5-digit NAICS industry 62134 contains a single 6-digit national industry:

Because the split from 5-digit to 6-digit adds no further subdivision here, 62134 and 621340 cover exactly the same establishments, the same four professions (PT, OT, SLP, and audiology), and the same office-based outpatient model.[1] Every figure, driver, and risk on the child page applies unchanged to this level.

Full detail lives in the child primer (621340) — scope inclusions/exclusions (hospitals, nursing homes, home health, and schools are not counted here), ownership mix, the investable-universe roster, per-visit economics, Medicare rules, and consolidation history. This page keeps only the rollup essentials.

3. Size (this level's figures)

Our federal statistics for NAICS 62134 are the same numbers reported for 621340 (the two are one and the same industry):

That works out to roughly 9 employees per establishment and about $1.35 million of receipts per firm — small-business economics. The industry is not concentrated: the four largest firms hold 12.9% of receipts (the "CR4," or four-firm concentration ratio), the top 8 hold 18.2%, the top 20 hold 26.3%, and even the top 50 hold only 33.1%.[2] (The Herfindahl-Hirschman Index, or HHI, a standard single-number concentration gauge, is suppressed in our source and should not be estimated — but these ratios already confirm a highly fragmented market.[2])

Undercount caveat. These figures cover employer establishments with paid employees and exclude the self-employed and most government workers.[3][4] Because this industry is dominated by small, owner-operated practices — and because most therapists actually work outside "offices" (in hospitals, nursing homes, home health, and especially schools) — the code understates the professions' true footprint. The Bureau of Labor Statistics (BLS) counts roughly 630,000 licensed PTs, OTs, SLPs, and audiologists nationwide, versus the ~467,000 total people (clinicians plus support staff) employed inside this code.[6][7][8][9] The office-based industry captures perhaps half of these professions' labor.

4. Investable universe (where value concentrates)

Because this level is its one child, value concentrates exactly where the child primer maps it — and it concentrates thinly. The four largest operators together hold under 13% of receipts,[2] so the great majority of the industry sits outside any brand, in tens of thousands of independent single- and multi-clinic practices.

Pure-play public operators are few — essentially U.S. Physical Therapy (USPH) and the more diversified Select Medical (SEM) after ATI Physical Therapy was taken private in 2025. Most capital deployed against this industry is private: private-equity platforms (Upstream, Athletico, PT Solutions, Ivy Rehab, CORA) and, at the smallest end, direct ownership of individual clinics. See the child primer (621340) for the full roster, tickers, clinic counts, and platform detail.[12][14][16]

5. How the money works

Owners here run a labor-driven service business: revenue is roughly completed visits × net revenue per visit, plus employer, contract, and ancillary services. Payment comes from commercial insurers, Medicare, Medicaid, workers' compensation, employers, and patients. The levers are payer mix (workers'-comp and commercial pay most, Medicaid least — often a 30–40% per-visit swing), clinician productivity and utilization, and labor cost, which typically runs 50–60% of revenue and is the dominant expense.[19][20] Public operators report about $100–$106 net revenue per visit, and run-of-the-mill clinic net margins land around 12–25%.[12][14][20] Consolidators additionally chase multiple expansion — buying single clinics cheaply and folding them into a higher-valued platform. Full per-visit mechanics (the Medicare "8-minute rule," units per visit, break-even utilization) are in the child primer.

6. Demand drivers

• Aging population — the core tailwind; more age brings more joint replacements, falls, stroke, Parkinson's, dementia, and swallowing disorders, all rehab-intensive.[10]
• Faster-than-average occupational growth — BLS projects 2024–2034 employment growth of about 11% (PTs), 14% (OTs), 15% (SLPs), and 9% (audiologists).[6][7][8][9]
• Post-surgical and orthopedic volume, and therapy as a lower-cost, non-drug alternative to procedures and opioids.[11]
• Neurological and pediatric OT/SLP demand (stroke, autism, early intervention).[8]
• Direct access — as of July 2025 all 50 states plus DC allow some form of patient self-referral to PT, shortening paths to treatment.[24]

The main offset is supply: a clinician shortage can turn strong demand into higher wages rather than higher profit.

7. Regulation

Government payment rules and state licensure shape economics more than product regulation does. The Medicare Part B fee schedule sets a "conversion factor" that has been cut repeatedly (to $32.35 in 2025), and because commercial and workers'-comp payers benchmark off Medicare, those cuts ripple across the whole book.[21][23] Other load-bearing rules: the therapy threshold / KX modifier ($2,480 for 2026), the 85% assistant payment differential for PTA/OTA-furnished care, state licensure and corporate-practice-of-medicine limits that push investors into management-services-organization (MSO) and clinician-partnership structures, the Stark Law and Anti-Kickback Statute, HIPAA privacy rules, and — for audiology — the FDA's 2022 over-the-counter hearing-aid rule.[22][25][23] See the child primer for the detailed regulatory map.

8. Consolidation

The defining feature is fragmentation with a consolidation overhang: with the top 50 firms holding just a third of revenue,[2] private equity spent roughly two decades building roll-up platforms. That cycle has cooled sharply — reportedly near-zero platform buyouts announced in 2024 — as higher interest rates raised the cost of debt-funded deals, Medicare cuts squeezed revenue, and clinician wage inflation squeezed costs.[11][25] ATI's 2025 take-private and Athletico's 2026 recapitalization are the visible scars.[17][14] Competition is local even when ownership is national; durable edges are payer-contracting scale, referral relationships, clinician retention, and compliant revenue-cycle infrastructure.

9. Risks

• Reimbursement erosion — serial Medicare conversion-factor cuts, the assistant differential, and prior authorization steadily lower the per-visit ceiling; commercial payers follow Medicare down.[21][22]
• Labor scarcity and cost — clinicians are scarce and mobile; wage inflation flows straight to margin and caps capacity.[20]
• Payer-mix and volume sensitivity — a shift toward Medicare/Medicaid, or a soft referral environment, can quickly turn a clinic unprofitable.[19][20]
• Roll-up and leverage risk — the model relies on debt; over-levered consolidators face distress when rates rise and reimbursement falls together (ATI, Athletico).[18][26]
• Compliance and audit exposure, local-market risk, and substitution (tele-rehab, digital PT apps, OTC hearing aids).[25][23][22]
• Small-operator vulnerability — the typical clinic is a small business with little capital to absorb a bad reimbursement year or a key clinician's departure.

10. How to invest and the outlook

Public-market routes are narrow: U.S. Physical Therapy (USPH) is the cleanest listed outpatient-rehab exposure, Select Medical (SEM) offers a version blended with specialty and rehabilitation hospitals, and there is no dedicated outpatient-rehab exchange-traded fund (ETF). Private-market routes — where most capital actually goes — range from buying and operating a single clinic to backing a regional platform with clinician rollover equity, funding de-novo clinics, or providing acquisition financing. Diligence should center on payer contracts, revenue by billing code and payer, completed visits per episode, referral concentration, clinician retention, state ownership rules, and the quality of prior acquisitions. (Tickers, prices, and valuation multiples change daily and are not investment advice.)

The long-run demand case is unusually clear — an aging population needs more rehabilitation, and therapist occupations are projected to grow faster than the overall workforce. The open question is who captures the value: fragmented independents, disciplined private platforms, or the two public operators. For now the profession is growing faster than the payment system is paying, which rewards operators who win on payer mix, productivity, compliant billing, and clinician retention rather than on financial engineering.

For the complete treatment — scope, ownership mix, the full investable roster, per-visit economics, the detailed regulatory map, and consolidation history — see the child primer, NAICS 621340.

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Sources

1. U.S. Census Bureau, "2022 NAICS Definition — 621340: Offices of Physical, Occupational and Speech Therapists, and Audiologists." https://www.census.gov/naics/?details=621340&year=2022
2. U.S. Census Bureau, "2022 Economic Census — Concentration and receipts, NAICS 621340" (firms 31,682; receipts $42.796B; CR4 12.9%, CR8 18.2%, CR20 26.3%, CR50 33.1%; HHI suppressed), 2022.
3. U.S. Census Bureau, "County Business Patterns 2023 — NAICS 621340" (establishments 52,058; employment 466,903; annual payroll $22.910B; Q1 payroll $5.491B). https://data.census.gov/table/CBP2023.CB2300CBP
4. U.S. Census Bureau, "County Business Patterns Methodology" (excludes self-employed and most government employees), 2025. https://www.census.gov/programs-surveys/cbp/technical-documentation/methodology.html
5. U.S. Bureau of Labor Statistics, "Occupational Outlook Handbook: Physical Therapists" (~267,200 jobs, 2024; ~11% projected growth 2024–34). https://www.bls.gov/ooh/healthcare/physical-therapists.htm
6. U.S. Bureau of Labor Statistics, "Occupational Outlook Handbook: Occupational Therapists" (~160,000 jobs, 2024; ~14% growth). https://www.bls.gov/ooh/healthcare/occupational-therapists.htm
7. U.S. Bureau of Labor Statistics, "Occupational Outlook Handbook: Speech-Language Pathologists" (~187,400 jobs, 2024; ~15% growth). https://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm
8. U.S. Bureau of Labor Statistics, "Occupational Outlook Handbook: Audiologists" (~15,800 jobs, 2024; ~9% growth). https://www.bls.gov/ooh/healthcare/audiologists.htm
9. U.S. Census Bureau, "Demographic Turning Points for the United States: Population Projections for 2020 to 2060" (one in five of retirement age by 2030; older adults outnumber children by 2034), 2020. https://www.census.gov/library/publications/2020/demo/p25-1144.html
10. Marketdata / ResearchAndMarkets, "U.S. Physical Therapy Clinics 2024/2025: An Industry Analysis" (~$53B market; six largest chains ~$4.07B revenue / ~4,949 clinics; M&A slowdown), 2025. https://www.globenewswire.com/news-release/2025/05/02/3073073/28124/en/U-S-Physical-Therapy-Clinics-Market-Analysis-2025.html
11. U.S. Physical Therapy, "Fourth Quarter and Full-Year 2025 Results" (779 clinics, 44 states, Sept 2025; 32.2 visits per clinic per day; $105.76 net revenue per visit), SEC, 2026. https://www.sec.gov/Archives/edgar/data/885978/000088597826000009/ex99-1.htm
12. Select Medical Holdings Corporation, "2025 Form 10-K" (1,917 outpatient rehab clinics at year-end 2025; ~$1.285B outpatient revenue; ~11.5M visits; ~$100 net revenue per visit), SEC, 2026. https://www.sec.gov/Archives/edgar/data/1320414/000132041426000007/sem-20251231.htm
13. ATI Physical Therapy, Inc., "2024 Form 10-K" (866 clinics, 24 states), U.S. SEC, 2025. https://www.sec.gov/Archives/edgar/data/1815849/000181584925000015/ati-20241231.htm
14. ATI Physical Therapy, "ATI Physical Therapy Goes Private" (Knighthead Capital Management / Marathon Asset Management consortium; 2025). https://www.atipt.com/ati-goes-private/
15. ATI Physical Therapy, Inc., "ATI Physical Therapy Announces Reverse Stock Split" (1-for-50 reverse split; going-concern disclosure), PR Newswire, 2023. https://www.prnewswire.com/news-releases/ati-physical-therapy-announces-reverse-stock-split-301850369.html
16. PT Everywhere, "A Look at the Best Payer Mix for a Physical Therapy Clinic" (workers'-comp vs. commercial vs. Medicare rates; ~$95–$115 per visit; units per visit), 2025. https://www.pteverywhere.com/media/a-look-at-the-best-payer-mix-for-a-physical-therapy-clinic
17. KMF Business Advisors, "Physical Therapy Clinic Profitability in 2026" (payroll 50–60% of revenue; 12–25% net margin; visits per therapist per day; utilization), 2026. https://www.kmfbusinessadvisors.com/physical-therapy-clinic-profitability-2026-financial-insights/
18. PatientStudio / APTA, "2025 Physical Therapy Reimbursement Rates" (conversion factor $32.35, down 2.83% from $33.29; 2025 KX threshold $2,410), 2025. https://www.patientstudio.com/2025-physical-therapy-reimbursement-rates
19. Centers for Medicare & Medicaid Services, "Therapy Services" (2026 KX threshold $2,480 PT+SLP / $2,480 OT; 85% assistant rate; 50% MPPR; telehealth authority through 2027; remote therapeutic-monitoring codes), 2026. https://www.cms.gov/medicare/coding-billing/therapy-services
20. Medbridge / APTA, "Physician Fee Schedule 2025–2026: PTA general supervision; 2.5% efficiency adjustment," 2025. https://www.medbridge.com/blog/major-wins-for-therapy-providers-in-the-finalized-physician-fee-schedule-for-2025
21. American Physical Therapy Association, "Direct Access by State" (all 50 states + DC + USVI allow some direct access; 21 unrestricted, 2025) and "PT Compact." https://www.apta.org/advocacy/issues/direct-access-advocacy/direct-access-by-state
22. Centers for Medicare & Medicaid Services, "Physician Self-Referral (Stark Law)," 2026. https://www.cms.gov/medicare/regulations-guidance/physician-self-referral
23. U.S. Food and Drug Administration, "FDA Finalizes Historic Rule Enabling Access to Over-the-Counter Hearing Aids" (effective October 2022), 2022. https://www.fda.gov/news-events/press-announcements/fda-finalizes-historic-rule-enabling-access-over-counter-hearing-aids-millions-americans
24. Global Market Insights / Lexie Hearing, "U.S. OTC Hearing Aids Market" and "Medicare hearing-aid coverage" (Original Medicare excludes hearing aids; Medicare Advantage benefits; device economics), 2025–2026. https://www.gminsights.com/industry-analysis/us-otc-hearing-aids-market
25. Scope Research, "Physical Therapy Valuation Multiples and M&A Trends 2025" (post-2021 M&A slowdown; multiple compression), 2025. https://www.scoperesearch.co/post/physical-therapy-valuation-multiples-and-m-a-trends-2025
26. Athletico Physical Therapy, "Athletico Agrees to Comprehensive Recapitalization and Secures Significant New Capital" (~$80M new financing; ~$750M net-debt reduction), 2026. https://www.athletico.com/press-room/athletico-agrees-to-comprehensive-recapitalization-and-secures-significant-new-capital/