The Physical Therapy Tracker
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In Q3 2025, Livingstone's healthcare team published an article highlighting U.S. Physical Therapy's ("USPH") strong Q2 2025 earnings beat and calling for the beginning of the next phase of a physical therapy bull market. After enduring five consecutive years of Medicare reimbursement pressure, wage inflation, and demand materially outpacing clinical capacity, Livingstone identified early 2025 as the trough for the outpatient PT industry with the sector's strongest operating quarters still ahead.
Since that publication, the data has continued to validate that thesis.
In 2025, USPH delivered ~15% visit volume growth, followed by an additional ~7% growth in Q1 2026. Reimbursement trends also improved modestly throughout 2025 and into Q1 2026 relative to comparable prior-year periods, signaling a healthier and more constructive operating environment across the sector.
The bulls are running.
Physical therapy consolidation has been underway for more than two decades, yet immense fragmentation persists. Of the ~37,000 outpatient physical therapy clinics nationwide, the 30+ scaled platform consolidators collectively operate roughly 11,500 clinics, representing only 31% of the total market footprint. The "Big Six" operators — Select Medical, Upstream Rehabilitation, Confluent Health, Athletico, ATI, and USPH — account for ~20% of industry clinic share, leaving substantial runway for continued consolidation.
While multiple sale processes during 2024 and 2025 stalled at diligence, industry fundamentals continue to improve and 2026 is increasingly shaping up to be the next meaningful wave of transaction activity.
Hover over any platform on the chart below to highlight platform headquarters and investor ownership.
Each dot represents a scaled outpatient physical therapy platform — including private equity-backed consolidators, public operators, and franchise models — with meaningful national or regional clinic density. Hover over any dot to view a quick-reference profile including clinic count, sponsor ownership, headquarters location, and the platform's corresponding geographic footprint.
U.S. Physical Therapy is the only pure-play public outpatient physical therapy operator following Select Medical's announced take-private transaction in March 2026 at a $3.9B enterprise value. Live quote and daily trading data are sourced via Twelve Data, while the valuation snapshot and quarterly trading multiples — including EV/EBITDA and EV/Revenue — are calculated using Alpha Vantage quarterly 10-Q data and the daily price series. Interactive chart overlays, including volume, 200-day moving average, and relative performance versus the S&P 500, can be toggled independently.
Livingstone maintains a proprietary benchmarking index of key performance indicators across privately held outpatient physical therapy operators, ranging from single-state regional platforms to scaled multi-state consolidators. The index is compiled through proprietary industry channels and reflects a diversified basket of PT operators varying by size, business mix, geographic footprint, and operating performance.
Use the index to benchmark where a prospective platform or add-on acquisition falls relative to the broader institutional cohort across the key metrics that most directly influence valuation, scalability, and buyer interest.
Platform valuation multiples have expanded materially over the last decade. From 2020 to 2026, outpatient PT platforms above $400 million in enterprise value traded at an average EBITDA multiple of approximately 13.6×, compared to roughly 10.5× during the preceding five-year period. Similarly, sub-$200 million platforms now routinely command valuation multiples near ~12× versus approximately ~9× prior to 2020.
At the same time, add-on acquisition activity accelerated significantly throughout 2020 to 2026, with ~500 announced outpatient PT transactions tracked by Livingstone since 2005. Despite elevated consolidation activity, the South and West remain comparatively underpenetrated relative to population growth and demographic migration trends, suggesting substantial remaining runway for continued M&A activity.
| Date | Acquirer / Sponsor | Target / Detail | Geography | Type | Disclosed Value |
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PT platforms competing for scale today execute against a recognizable four-pillar strategy — but how those pillars are sequenced, weighted, and reinforced is where exit value is made or lost. The full playbook, along with our Value Drivers & Detractors framework, is best discussed in conversation rather than in print.
Independent operators face an increasingly difficult environment as regulatory, compliance, and payor pressures rise alongside macro cost inflation. Scaled platforms enjoy structural advantages across six dimensions — and these advantages are compounding as the value-based care (VBC) transition accelerates under MIPS and CMS's 2030 accountable-care target.
Federal reimbursement structure is in active transition. The CY2026 Physician Fee Schedule introduces a two-tier Medicare rate; MIPS sunsets after 2027 in favor of value-based pathways; the One Big Beautiful Bill Act (2025) cut ~$930B in projected federal Medicaid spending over ten years — with disproportionate exposure for pediatric and early-intervention therapy practices.
Livingstone's Healthcare practice is one of the most active M&A advisors to the outpatient physical therapy sector across the middle-market. Reach the team directly below.
