Offices of Physical, Occupational and Speech Therapists, and Audiologists (NAICS 621340)

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

1. Overview

This is the outpatient rehabilitation industry: the neighborhood physical-therapy (PT) clinic where someone 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 federal statistics these four professions are combined into one industry code — NAICS 621340 (the North American Industry Classification System) — because they share a business model: licensed clinicians treating patients in office-based clinics and billing insurers per visit.[1]

Why it matters to an investor: it is a large, growing, and unusually fragmented slice of U.S. health care. Roughly 52,000 clinics generate more than $42 billion in receipts, yet the four largest operators together hold under 13% of revenue.[2][3] That combination — durable demand from an aging population plus a sea of small owner-operated practices — has made it a classic "roll-up" target: buy small clinics, bolt them onto a platform, and gain scale in payer contracting. It is also a cautionary tale, because reimbursement cuts, high interest rates, and labor costs have punished over-leveraged consolidators.

There are two broad ways in. Public-market investors can own a small set of listed outpatient-rehab operators, but genuine pure-plays are scarce — and one of the largest, ATI Physical Therapy, was taken private in 2025 after nearly collapsing. Private-market investors dominate this space through private-equity platforms (Upstream, Athletico, PT Solutions, Ivy Rehab) and, at the smallest end, direct ownership of individual clinics — where a single well-run practice can be bought and operated like any local service business. The economic asset in either case is the same: licensed clinical labor, local referral relationships, payer contracts, and clinic capacity — not equipment or inventory.[2] Returns depend more on clinician retention, payer pricing, compliant billing, clinic utilization, and acquisition discipline than on demographic growth alone.

2. What it is and how it is structured

Scope. NAICS 621340 covers establishments of independent PTs, OTs, SLPs, recreational/industrial therapists, and audiologists operating private or group practices in their own offices — clinics and centers — or in others' facilities.[1] The unifying feature is office-based outpatient care: the patient comes to the clinic and walks (or is wheeled) out the same day. The four professions cover:

• PT — injury recovery, mobility and pain, neurological rehabilitation, prevention and wellness.
• OT — functional independence in daily activities, developmental conditions, neurological recovery, workplace rehabilitation.
• SLP — speech, language, voice, communication, and swallowing disorders.
• Audiology — diagnosis and treatment of hearing and balance disorders, including hearing-aid fitting.[1]

Typical business formats range from solo-clinician practices and small groups to regional clinic networks, national platforms, hospital-affiliated outpatient centers, school contracts, employer programs, and home-based services.

What it excludes (important, because it defines where the money isn't counted here):

• Offices of physicians (NAICS 621111) and other practitioners such as dentists (621210), chiropractors (621310), optometrists (621320), mental-health practitioners (621330), and podiatrists/miscellaneous practitioners (621391/621399) — separate codes even when co-located.
• Hospitals (NAICS 622) — a huge employer of therapists, but their inpatient and hospital-outpatient rehab is booked under the hospital, not here.
• Nursing and skilled-nursing facilities (NAICS 623), home health care services (NAICS 621610), and vocational rehabilitation services (NAICS 624310) — where much geriatric and post-acute therapy actually happens.
• Schools (NAICS 611) — where a large share of speech-language pathologists and pediatric OTs work; school therapy is education-sector employment, not this industry.
• Fitness and sports-instruction businesses, and hearing-aid retailers and manufacturers — audiology offices are in-scope, but standalone hearing-aid stores and device makers sit in retail/manufacturing codes.

So the same clinical work can land inside or outside 621340 depending on who employs the therapist and where the visit is booked.[1]

Ownership mix. Historically owner-operated: a licensed therapist owns one or a few clinics, and that remains the dominant form. The Economic Census counted about 31,700 firms running roughly 52,000 establishments — meaning most firms are single-location.[2][3] Layered on top are (a) private-equity-backed regional and national chains, (b) a handful of publicly traded operators, (c) health-system-affiliated outpatient centers, and (d) partnership models — the largest public operator (U.S. Physical Therapy) typically buys a majority stake (about 65–75%) of a clinic and leaves the founding therapist a minority interest to keep them incentivized.[13] Private equity often operates through management-services organizations (MSOs) and clinician-partnership structures because some states restrict non-clinician ownership of a clinical practice (see Regulation). The federal data do not publish an ownership-mix percentage, so no precise split should be inferred.

3. How big it is

Our federal statistics for NAICS 621340:

That works out to about 9 employees per establishment and roughly $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]) The $12.5 million SBA threshold is a size-eligibility standard, not the average practice's revenue or the industry's total market.[5]

Undercount and scope caveats. These figures do not capture all therapy activity. County Business Patterns covers employer establishments with paid employees and excludes the self-employed and most government workers.[3][4] Two things therefore make the professions bigger than this code suggests:

• Many therapists work outside "offices." The Bureau of Labor Statistics (BLS) counts roughly 267,000 physical therapists, 160,000 occupational therapists, 187,000 speech-language pathologists, and 16,000 audiologists nationwide (2024).[6][7][8][9] That is about 630,000 licensed clinicians — but NAICS 621340 employs only ~467,000 total people (clinicians plus front-desk staff, aides, and assistants).[3] The gap sits in hospitals, nursing homes, home health, and especially schools (where most SLPs practice). The office-based industry captures perhaps half of these professions' labor.
• The market is a moving target. Private market-research houses estimate the U.S. outpatient physical/occupational therapy clinic market at about $53 billion in 2024, above the Census 2022 receipts figure — reflecting a later year, real growth, and a somewhat broader definition.[11] Both numbers are directionally consistent: a large, expanding, low-concentration industry.

4. The investable universe

Pure-play public operators are few, and after ATI's 2025 take-private the listed set is essentially two names.

Public companies

Neither is a pure representation of 621340: USPH includes industrial injury-prevention services, and hospital economics drive much of Select Medical. There is no dedicated outpatient-rehab exchange-traded fund (ETF), and other hospital or health-care stocks may contain therapy activity that is not separately disclosed.

Major private platforms and other owners (not directly investable in public markets)

• ATI Physical Therapy — 866 clinics in 24 states at year-end 2024. After a 2021 SPAC (special-purpose acquisition company) listing at a rich valuation, ATI did a 1-for-50 reverse stock split and flagged going-concern doubt; a consortium led by Knighthead Capital Management and Marathon Asset Management took it private in 2025 — the industry's cautionary tale of leverage meeting falling reimbursement.[16][17][18]
• Athletico Physical Therapy — a large private, founder-originated platform with 900+ locations and 9,000+ clinicians and team members. In 2026 Athletico announced roughly $80 million of new financing and about $750 million of net-debt reduction — a recapitalization that shows how much leverage private roll-ups can carry.[37]
• Upstream Rehabilitation — a national outpatient-rehab provider (owned, managed, and joint-venture clinics) backed by Revelstoke Capital Partners; an active acquirer.[35][31]
• Confluent Health / PT Solutions — Partners Group invested in Confluent Health in 2019; its PT Solutions unit describes itself as privately held with 550+ points of service across 25 states.[32][33]
• Ivy Rehab — a Waud Capital Partners portfolio company; outpatient orthopedic PT/OT plus pediatric PT, OT, SLP, and applied-behavioral services.[34]
• CORA Physical Therapy — acquired by H.I.G. Capital in 2021, when it ran 228 clinics across nine states; Professional Physical Therapy is another regional chain. Current scale and ownership terms should be confirmed in diligence.[36]
• Plus tens of thousands of independent single- and multi-clinic practices.

Scale context: the six largest chains combined generated about $4.07 billion of revenue across ~4,949 clinics in 2024 — under 10% of all clinics — underscoring how much of the industry sits outside any brand.[11] On the audiology side, the office channel is heavily influenced by hearing-aid manufacturers and retail networks (Sonova, Amplifon, Demant) that sit in adjacent device/retail codes, not in 621340. Private ownership changes frequently and private operators disclose little, so this list is illustrative, not exhaustive.

5. How the money works

Owners here run a labor-driven service business. A simple framing:

Revenue ≈ completed visits × net revenue per visit, plus employer, contract, and ancillary services.

Revenue comes from commercial insurers, Medicare, Medicaid, workers' compensation, employers, and patients; what a clinic collects depends on billing codes, medical necessity, payer contracts, authorization rules, and geography. The levers that matter:

• Reimbursement per visit (payer mix). The single biggest profit driver. Clinics bill using timed treatment codes (Current Procedural Terminology, or CPT, codes) under Medicare's "8-minute rule," which converts minutes of hands-on care into billable 15-minute "units." A typical visit runs roughly 3.0–3.8 units and nets about $95–$115; public operators report about $100–$106 net revenue per visit (USPH ~$105.76, Select Medical ~$100 in 2025).[12][14][19] Rates vary sharply by payer: workers' compensation pays the most, commercial insurance next (often 100–140% of Medicare), then Medicare, then Medicaid. A clinic weighted toward workers'-comp and commercial can earn 30–40% more per visit than a Medicare/Medicaid-heavy one — so payer mix, more than raw volume, sets margins.[19]
• Clinician productivity and utilization. Revenue is capacity-limited by therapist hours, so practices track visits per therapist per day and utilization (share of the workday in billable treatment). Below roughly 9 visits per PT per day a clinic is unprofitable at standard rates; strong clinics run ~1.8–2.2 visits per therapist-hour.[20] Assistants — physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) — leverage the licensed clinician's time but are paid less and, under Medicare, bill at a reduced rate (see Regulation).
• Labor cost. Payroll is typically 50–60% of revenue, the dominant expense.[20] Because clinicians are scarce, wage inflation flows almost directly into margin. Net margins for a run-of-the-mill clinic land around 12–25%, depending on payer mix and staffing.[20]
• Operating leverage vs. the capacity ceiling. Extra visits that use existing rooms and staff drop through at high margin — but adding rooms without therapists creates no revenue, so labor is both the lever and the limit.
• De-novo vs. acquisition growth. Operators grow by opening satellite clinics ("de novo" — cheap but slow to fill) or buying existing practices. For consolidators the arbitrage is multiple expansion: buy a single clinic at a low multiple of earnings, fold it into a platform, and have the combined entity valued at a higher multiple. That thesis works only when acquisition prices, borrowing costs, and reimbursement all cooperate — which, recently, they have not (see Competitive Dynamics).

Beyond the headline levers, disciplined operators watch the smaller dials that quietly move cash flow: cancellation and no-show rates, referral-to-evaluation conversion and whether patients complete the full prescribed course of care, denial rates and authorization delays on the revenue-cycle side, rent and local operating costs, and — for acquirers — acquisition payback and clinic ramp time.

The industry is less cyclical than elective retail but not recession-proof: elective orthopedic, sports, and employer-related visits can soften, while Medicare and post-acute demand are more defensive. Audiology economics differ from therapy: those offices lean less on repeat visits and more on diagnostic testing plus hearing-aid device sales and fittings, where device margin — and increasingly competition from over-the-counter (OTC) devices — drives the profit and loss.

6. What drives demand

• Aging population. The core tailwind. The Census Bureau projects that one in five Americans will be of retirement age by 2030 and that older adults will outnumber children by 2034, with the 65-and-over population climbing through 2040.[10] More age brings more orthopedic surgery, joint replacements, falls, stroke, Parkinson's, dementia, and swallowing disorders — all rehab-intensive.
• Occupational growth. BLS projects 2024–2034 employment growth of about 11% for PTs, 14% for OTs, 15% for SLPs, and 9% for audiologists — all faster than the all-occupation average.[6][7][8][9]
• Post-surgical and orthopedic volume. PT demand tracks elective surgery (knees, hips, shoulders, spine) and sports injuries; higher surgical volumes feed referrals directly.
• Therapy as an opioid alternative and a lower-cost setting. Payers and guidelines increasingly favor conservative, non-drug care for musculoskeletal pain, and outpatient therapy can substitute for costlier procedures or institutional care — steering patients to PT earlier. This is a business thesis, not a guarantee of financial performance.[11]
• Neurological, pediatric, and survivorship demand for OT/SLP. Stroke, Parkinson's, and dementia sustain adult SLP/OT demand; autism, developmental delay, and early-intervention programs sustain pediatric OT/SLP; and improved survival after trauma adds more.[8][38]
• Hearing loss and Medicare Advantage. An aging population and expanding hearing benefits inside Medicare Advantage plans support audiology visit volume, even as OTC devices reshape the device economics.[29]
• Direct access. As of July 2025, all 50 states, DC, and the U.S. Virgin Islands allow some form of direct access — patients can start PT without a physician referral (21 states unrestricted; the rest with limits, and payer referral/authorization rules can still apply).[24] Fewer gatekeepers means shorter paths to treatment and more visits.
• Digital care. Medicare rules for 2026 expanded certain remote therapeutic-monitoring codes and extended therapist telehealth authority through 2027, opening new billable channels.[22]

The main offset is supply: strong demand can produce higher wages rather than higher profits if clinics cannot recruit and retain qualified clinicians.

7. Regulation

This is a licensed, insurance-reimbursed industry, so government payment rules and state licensure shape economics more than product regulation does.

• Medicare Part B fee schedule. Outpatient therapy is paid under the Medicare Physician Fee Schedule, whose annual "conversion factor" sets the dollar value of each unit of work. That factor has been cut repeatedly — it fell to $32.35 in 2025, down 2.83% from $33.29 — and the Centers for Medicare & Medicaid Services (CMS) added a permanent 2.5% "efficiency adjustment" affecting some codes for 2026.[21][23] Because commercial and workers'-comp payers benchmark off Medicare, these cuts ripple across the whole book.
• Therapy threshold ("cap") and KX modifier. Medicare no longer hard-caps therapy spending but applies a threshold above which providers must attest medical necessity via a billing modifier (the "KX modifier"): $2,410 in 2025, rising to $2,480 for 2026 (combined PT+SLP, and a separate $2,480 for OT). A second, higher tier can trigger targeted audits.[21][22]
• Assistant payment differential. Services furnished in whole or part by PTAs/OTAs are reimbursed by Medicare at 85% of the therapist rate (flagged with CQ/CO modifiers) — a structural discount that shapes staffing mix. Separately, CMS in 2025 eased supervision rules, letting PTAs work under general rather than direct supervision in private practices.[22][23]
• Multiple Procedure Payment Reduction (MPPR). When several timed services are billed in one visit, Medicare cuts the practice-expense portion of the additional units by 50% — a persistent drag the profession lobbies against.[22]
• State licensure, direct access, and the PT Compact. Each profession is state-licensed with its own scope-of-practice and supervision rules, and direct-access rules do not necessarily eliminate a payer's referral or prior-authorization requirements. The Physical Therapy Compact lets therapists licensed in one member state practice in others without full re-licensure, easing multi-state staffing.[24]
• Referral, ownership, and fraud-and-abuse rules. The federal physician self-referral law (the Stark Law) covers physical, occupational, and outpatient speech-language pathology services, and the federal Anti-Kickback Statute restricts payments meant to induce federally reimbursed referrals.[25][26] Some states also enforce corporate-practice-of-medicine limits on non-clinician ownership, which is why investors use professional-entity, MSO, clinician-partner, or joint-venture structures — legality and governance must be reviewed state by state.
• Privacy and cybersecurity. The Health Insurance Portability and Accountability Act (HIPAA) applies to covered providers and their business associates handling protected health information.[27]
• Audiology / hearing aids. Original Medicare (Parts A and B) does not cover hearing aids, so device revenue is largely cash-pay or Medicare Advantage.[29] The FDA's October 2022 rule created a new over-the-counter hearing-aid category, letting adults with perceived mild-to-moderate loss buy devices without an audiologist — a change that pressures the traditional dispensing model.[28]

8. Competitive dynamics and consolidation

The defining feature is fragmentation with a consolidation overhang. With the top 50 firms holding just a third of revenue, there is a long runway for roll-ups — and for roughly two decades private equity chased it, building platforms like Upstream, Athletico, PT Solutions, and Ivy Rehab and bidding up regional chains.[2][31]

That cycle has cooled sharply. After a late-2021 M&A (mergers-and-acquisitions) peak, deal activity fell off — reportedly close to zero platform buyouts announced in 2024 — as higher interest rates raised the cost of debt-funded roll-ups, Medicare cuts squeezed the revenue line, and clinician wage inflation squeezed costs.[11][30] Valuation multiples compressed; the leveraged strategy that looked easy at low rates looked dangerous at high ones. ATI's take-private in 2025 and Athletico's 2026 recapitalization are the visible scars.[17][37]

Competition is local even when ownership is national, and the edges that still matter are: payer-contracting scale (national chains negotiate better commercial rates), referral relationships with orthopedic surgeons, physician groups, employers, and schools, clinician recruiting and retention in a tight labor market, convenient locations and density (clustering clinics to share overhead and cover more referral sources), specialty programs and measurable clinical outcomes, and revenue-cycle and compliance infrastructure. Vertically integrated players like Select Medical can feed their outpatient clinics from their own hospitals. In audiology, competition increasingly comes from outside the office channel — big-box retail, online sellers, and OTC devices.

Scale is not automatically an advantage: a roll-up can add corporate overhead, dilute local clinical culture, overpay for acquisitions, or grow debt faster than clinic cash flow. In this industry the durable consolidation thesis is usually "local clinical reputation plus better infrastructure," not simple brand standardization.

9. Risks

• Reimbursement erosion. Serial Medicare conversion-factor cuts, the assistant differential, prior authorization, and narrower networks steadily lower the ceiling on per-visit revenue; commercial payers tend to follow Medicare down.[21][22]
• Labor scarcity and cost. Clinicians are in short supply and highly mobile; wage inflation, contract labor, turnover, and burnout flow straight to the bottom line and directly cap capacity.[20]
• Payer-mix and volume sensitivity. A shift toward Medicare/Medicaid, or a soft referral environment, can turn a profitable clinic unprofitable quickly given the thin cushion above break-even utilization.[19][20]
• Roll-up and leverage risk. The model relies on debt, and acquisitions can conceal weak mature-clinic performance, payer concentration, or owner dependence; when rates rise and reimbursement falls together, over-levered consolidators face distress (ATI, Athletico).[18][37]
• Compliance and audit exposure. Inadequate documentation, upcoding, improper referrals, group-versus-individual billing, or weak supervision can trigger recoupments, penalties, litigation, or exclusion from federal programs.[25][26]
• Local-market risk. A single clinic can lose referrals, clinicians, or payer access even when the parent is nationally diversified.
• Technology, privacy, and substitution. Tele-rehab, digital PT apps, and — in audiology — OTC hearing aids chip at the office channel's pricing power, while electronic records, billing systems, and AI tools raise cybersecurity and data-governance exposure.[27][28][29]
• Classification and data risk. Federal business statistics understate self-employed and government activity and do not capture the full therapy ecosystem.[3][4]
• Small-operator vulnerability. The typical clinic is a small business with limited capital to absorb a bad reimbursement year, a key clinician's departure, or a lease shock.

10. How to invest and the outlook

Public-market routes. The listed set is small: U.S. Physical Therapy (USPH) is the cleanest outpatient-rehab pure-play; Select Medical (SEM) offers exposure blended with specialty and rehabilitation hospitals. With ATI now private, there is no third liquid pure-play and no dedicated outpatient-rehab ETF, so broad public exposure comes only indirectly through health-care-services or hospital funds. When analyzing the public names, watch mature-clinic visits per day, net revenue per visit, labor cost per visit, clinician turnover, payer mix, clinic openings/closures, acquisition returns, debt/lease obligations, and compliance disclosures — and separate organic volume growth from acquired revenue rather than valuing on headline revenue growth. (Tickers, share prices, and valuation multiples change daily and are not investment advice.)

Private-market routes. This is where most of the capital actually goes. Options range from buying and operating an individual clinic (a local, cash-generative service business bought at a modest multiple of earnings, subject to the same payer-mix and utilization math above), to backing a regional platform with clinician rollover equity, to funding de-novo clinics, providing acquisition financing or private credit, investing through an MSO/partnership structure, or partnering with a hospital or health system. Minimum diligence should cover payer contracts, revenue by billing code and payer, completed visits per episode, referral concentration, denial history, clinician retention, owner dependence, lease terms, state ownership rules, compliance audits, and the quality of prior acquisitions. For private buyers the current soft M&A market is double-edged: cheaper entry prices, but also the same rate and reimbursement headwinds that cooled the strategic buyers.

Near-term drivers to watch:

• The trajectory of the Medicare conversion factor and whether Congress reverses scheduled cuts — the swing factor for every operator's revenue line.
• Clinician wage trends and whether the labor shortage eases.
• A potential re-acceleration of M&A if interest rates fall and reimbursement stabilizes, which would re-open the roll-up arbitrage and support private valuations.
• In audiology, how fast OTC hearing aids and Medicare Advantage benefits reshape the device economics.

The long-run demand case is unusually clear — an aging population needs more rehabilitation, therapist occupations are projected to grow faster than the overall workforce, and public operators keep reporting high outpatient volumes. 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. The medium-term outlook is positive but uneven, and the real investment question is not whether Americans need more therapy — it is whether an operator can convert that need into reliable, well-reimbursed visits without overpaying for clinics or overleveraging the platform.

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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). 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. Small Business Administration, "Table of Small Business Size Standards — NAICS 621340 ($12.5M average annual receipts)," 2023.
6. 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
7. 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
8. 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
9. U.S. Bureau of Labor Statistics, "Occupational Outlook Handbook: Audiologists" (~15,800 jobs, 2024; ~9% growth). https://www.bls.gov/ooh/healthcare/audiologists.htm
10. 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
11. 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
12. 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
13. U.S. Physical Therapy, Inc., "Form 10-K" (partnership model; 65–75% clinic stakes), U.S. SEC. https://www.sec.gov/Archives/edgar/data/885978/000114036126007170/ef20060831_10k.htm
14. 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
15. Select Medical Holdings Corp., "Consummation of the Concentra Spin-Off" (Concentra distribution Nov 25, 2024), 2024. https://www.sec.gov/Archives/edgar/data/1320414/000162828024044570/sem-20240930.htm
16. 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
17. ATI Physical Therapy, "ATI Physical Therapy Goes Private" (Knighthead Capital Management / Marathon Asset Management consortium; 2025). https://www.atipt.com/ati-goes-private/
18. 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
19. 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
20. 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/
21. 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
22. 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
23. 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
24. 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
25. Centers for Medicare & Medicaid Services, "Physician Self-Referral (Stark Law)," 2026. https://www.cms.gov/medicare/regulations-guidance/physician-self-referral
26. U.S. Department of Health and Human Services, Office of Inspector General, "Fraud & Abuse Laws (Anti-Kickback Statute)," 2026. https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
27. U.S. Department of Health and Human Services, "HIPAA — Covered Entities and Business Associates," 2024. https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
28. 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
29. 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
30. 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
31. MatrixBCG, "Competitive Landscape of U.S. Physical Therapy" (Upstream, Athletico, PT Solutions as PE-backed acquirers), 2025. https://matrixbcg.com/blogs/competitors/usph
32. Partners Group, "Investment in Confluent Health," 2019. https://www.partnersgroup.com/en/news-and-views/press-releases/investment-news/detail?news_id=dbf22e8a-9a6c-4c53-af7d-8aca4d8c9e52
33. PT Solutions, "Our Story" (550+ points of service across 25 states), 2026. https://ptsolutions.com/about/our-story/
34. Waud Capital Partners / Ivy Health, "Ivy Rehab" (portfolio company; outpatient ortho PT/OT plus pediatric services), 2026. https://ivyhealth.com/
35. Revelstoke Capital Partners, "Upstream Rehabilitation" (national outpatient rehab; owned, managed, and JV clinics), 2026. https://revelstokecapital.com/investment/upstream-rehabilitation/
36. H.I.G. Capital, "H.I.G. Capital Signs Definitive Agreement to Acquire CORA Physical Therapy" (2021; 228 clinics across nine states). https://hig.com/news/h-i-g-capital-signs-definitive-agreement-to-acquire-cora-physical-therapy/
37. 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/
38. American Speech-Language-Hearing Association, "Market Trends in Audiology and Speech-Language Pathology," 2026. https://www.asha.org/Careers/Market-Trends/