Trends in Private Equity Acquisition of US Physical Therapy Clinics, 2010 to 2024.

Abstract

Private equity (PE) investments have expanded rapidly in procedural specialties such as orthopaedics. Physical therapy (PT) has become a newer target for PE investment because of reliable reimbursement, scalable operations, and recent policy reforms enhancing access. This study examines national trends in PE acquisitions of PT clinics, their geographic distribution, and PE exit trajectories. This cross-sectional study analyzed PE acquisitions of PT practices in the United States between January 1, 2010, and December 31, 2024. Acquisition data were drawn from PitchBook and supplemented through public verification. State and nationwide PT practice counts were estimated using the 2024 Medicare Care Compare database. PE acquistions in physical therapy expanded rapidly, from four deals in 2010 to 175 deals in 2023. By 2024, these acquisitions accounted for 2,591 PE-affiliated physical therpay clinics in the US, with 91.1% of the deals comprising of add-on acquisitions. PE penetration varied widely geographically, with Rhode Island (69.8%), Massachusetts (61.2%), and Tennessee (52.8%) having the highest proportions. Ten platform companies operated 59.3% of PE-affiliated PT locations in the United States, with notable regional concentration. The majority (63%) of acquisitions remained with the original PE firm, while 33.3% were sold to another PE firm with the average holding period being 3.3 years. PE investment in PT is marked by rapid growth, regional consolidation, and short-term investment cycles. Recent federal and state policy changes-including direct access laws and expanded referral authority-may have further facilitated PE entry into PT practices and contributed to the sector's investment appeal. Additional research is needed to evaluate the effect of PE ownership on care quality, access, and workforce stability.