Our Buyer Network
200+ Institutional Buyers.
Competing for Your Practice.
A selection of the platforms, PE-backed groups, and strategic operators in our active buyer network.
Mihama Acquisitions is the leading investment bank exclusively serving outpatient physical therapy, occupational therapy, and speech therapy practice owners. We exist to do one thing: help you achieve the best possible outcome in the most important transaction of your professional life.
Mihama was founded on a simple premise: practice owners in the PT, OT, and ST space deserve a dedicated advisor who understands their world—not a generalist investment bank that treats their transaction like any other middle-market deal.
Every engagement we take is structured around the same core belief: a well-run competitive process, executed with full confidentiality, will consistently produce better outcomes than direct negotiation. We have proven this across more than 250 closed transactions in 46 states.
Our strong preference is to work on the sell side. We avoid representing buyers so there is never a conflict of interest—our incentives are always aligned with yours. We carry no platform relationships, no preferred buyer arrangements, and we are only paid when your deal closes on terms you are proud of.
Start a Conversation"From start to finish, Mihama was impressive to say the least. They not only provided expert guidance through the entire process but also made us feel comfortable and truly cared for. If you choose Mihama, you will not be disappointed."— Anni Stafford, Owner · Hand Therapy of Wyoming
Not every M&A advisor is the same. These are the structural advantages we bring to every engagement.
We advise exclusively in the outpatient PT, OT, and ST space. This is not a niche we stumbled into—it is the only market we have ever served. That depth of focus means we understand your payor mix, your referral dynamics, and your buyer universe in a way no generalist firm can match.
Our strong preference is to work exclusively on behalf of sellers. We avoid buyer-side engagements so there is never a conflict of interest lurking in the background of a deal. No platform relationships, no preferred partners, no divided loyalty. When we sit across the table from a buyer on your behalf, we are entirely and unambiguously in your corner.
Every engagement receives a full suite of marketing materials—a confidential information memorandum, an anonymous teaser, and a proprietary data room—built to institutional standards. These materials are designed to position your practice as a premium asset, not merely describe it.
Our two-step auction creates a competitive environment where no buyer knows what others are bidding. This removes the incremental negotiation dynamic and forces each group to put forward their strongest valuation. It is the single most reliable driver of above-market outcomes we produce for our clients.
Your identity is never disclosed until a non-disclosure agreement is signed. Your staff, referral sources, and competitors remain unaware throughout the entire process. Site visits are conducted after hours. We manage every detail to ensure that if a deal does not close, it is as if the process never happened.
If you decide at any point not to move forward—after receiving LOIs, during due diligence, or at any other stage—you owe us nothing. There is no retainer, no break-up fee, and no pressure to close a deal that does not meet your standards. We only succeed when you do.
“I highly recommend anyone considering a sale to recognize that the value Mihama brings to the table far outweighs their cost. It is not even close.”— Eric Krell · Rocky Mountain Spine & Sport
The right buyer is not just a check. Institutional partners bring operational infrastructure, payer leverage, and growth capital that independent practices cannot replicate on their own. Understanding what is available changes how you think about what a deal is worth.
A blank checkbook to grow through acquisitions and de novo locations—without personal financial risk or the operational burden of self-funding expansion.
Revenue cycle management handled at the platform level, freeing your clinical team from the complexity and cost of billing operations entirely.
Dedicated marketing teams and brand infrastructure so you can concentrate on clinical excellence and organic growth rather than lead generation.
National payer contracts that individual practices simply cannot access, improving your net revenue on existing patient volume immediately upon close.
Immediate access to the buyer’s existing referral relationships in your region, providing a meaningful patient volume boost from day one.
Recruiting infrastructure and competitive employee benefits that attract top clinical talent—without the cost and complexity of building those systems yourself.
Reduce concentrated equity exposure and diversify your personal wealth beyond the single asset of your practice—a structurally sound financial decision at any stage.
Retain a minority equity stake that grows with the platform, creating a second—often larger—liquidity event when the buyer eventually recapitalizes or sells.
A selection of the platforms, PE-backed groups, and strategic operators in our active buyer network.
Private equity consolidation in the PT, OT, and ST space is among the most active in healthcare services today. Institutional buyers have raised significant capital and are actively deploying it to build regional and national platforms. The multiples being offered to independent practice owners right now reflect that competition.
But markets do not stay this way forever. The clearest historical parallel is the independent pharmacy sector. When CVS, Walgreens, and Rite Aid began their national consolidation push, independent pharmacy owners who sold during peak activity captured premium valuations—often multiples that seemed extraordinary at the time. The logic was straightforward: acquiring an established location with an existing patient base, trained staff, and community relationships was faster and cheaper than building from scratch.
Then the math changed. As CVS and Walgreens expanded their footprints and their construction and staffing costs became predictable at scale, it became cheaper to open a new location than to acquire an existing one. The acquisition premium evaporated almost overnight. Independent pharmacies that waited too long found that the buyers who once competed aggressively for their businesses had simply stopped calling. The window did not gradually close—it shut.
The same structural dynamic is playing out in outpatient rehab today. As PE-backed platforms mature and their regional footprints grow, their de novo development costs compress. The premium they place on your existing patient base, referral relationships, and operational infrastructure is real and meaningful right now—but it is not permanent.
A valuation is not just a curiosity. It is a defense of your net worth. Knowing what your practice is worth today—and what the market will pay—is the most important financial intelligence a practice owner can have. The cost of finding out is zero. The cost of waiting too long can be measured in millions.
Institutional buyers have raised record-level healthcare funds and are under pressure to deploy capital. Your practice is a competitive target—today. That competitive pressure is what drives premium multiples.
When CVS and Walgreens consolidated the independent pharmacy market, sellers who acted at peak activity captured premium valuations. Then the math changed—at a certain point, it became cheaper for those chains to open a new location than to acquire an existing one. Acquisition premiums collapsed, and the window closed faster than most owners anticipated. The PT/OT/ST space is following the same arc.
The most successful founders sell when their business is at its strongest—growing revenue, healthy EBITDA, expanding footprint. Buyers pay for momentum. A practice in decline, or one that simply waited too long, commands a fraction of what peak performance would have generated.
Once acquisition premiums compress, buyers shift to building rather than buying. At that point, your years of relationship-building, your referral network, and your operational infrastructure are no longer worth what they are today. The window is real—and finite.
Understanding your valuation costs nothing and commits you to nothing. But it gives you the market intelligence to make the most consequential financial decision of your professional life from a position of knowledge, not guesswork.
The best time to explore a sale is when you don’t have to. When your practice is growing, your team is strong, and your metrics are compelling—that is exactly when the market pays the most. Strength commands a premium. Necessity rarely does.
Between declining Medicare reimbursement rates, rising wage inflation, and the escalating cost of clinical recruitment, running an independent outpatient practice has never been more complex. You are competing for talent and payer contracts against well-capitalized, national platforms. A strategic partnership levels the playing field—granting you instant access to national payer rates, comprehensive employee benefits to retain staff, and the capital to grow without personal financial risk.
Reimbursement rates for independent practices have faced consistent downward pressure for years. Institutional platforms negotiate national payer contracts that individual owners simply cannot access. The gap between what an independent practice is reimbursed and what a platform-affiliated clinic earns for the same service is widening—and it compounds annually.
Recruiting and retaining top clinical talent has become one of the defining operational challenges for independent owners. Platform buyers offer nationalized HR infrastructure, competitive benefits, 401(k) match, and career development pathways that independent practices cannot replicate. The talent competition is no longer between practices—it is between independence and institutional backing.
Federal billing compliance, coding audits, HIPAA obligations, and documentation requirements continue to grow in scope and enforcement risk. Independent owners absorb this complexity personally. Institutional platforms have dedicated compliance teams, legal infrastructure, and the scale to manage regulatory risk that a single-owner practice carries alone.
Across 46 states since the start of the pandemic—representing hundreds of founders who chose to act while market conditions were favorable and their practices were at peak value.
Private equity-backed platforms, strategic operators, and regional consolidators—all actively competing for quality practices. That competition is what creates premium multiples for our sellers.
Selling a practice is the most consequential financial decision of your life. We have run this process hundreds of times. Here are the questions every seller asks—answered plainly.
Proprietary research from Mihama's healthcare M&A practice — written to help owners make informed, confident decisions about their transition.
Most owners leave significant money on the table by going to market without optimizing their financials first. This paper details four proven restructuring strategies that Mihama uses to boost EBITDA and increase enterprise value before the auction begins.
A QoE audit is the single biggest threat to your valuation between LOI and close. This guide walks through exactly what third-party accountants examine and how Mihama defends your number through the process.
From FCA exposure and Stark Law compliance to lease assignments and corporate record hygiene — this paper maps every legal checkpoint buyers run during diligence.
Billing irregularities, supervision violations, and unlicensed aide usage are the compliance flags that give buyers leverage to reprice or walk. This paper provides a practical remediation framework.
Your top clinician is your most valuable growth asset. This paper shows how minority equity stakes, structured compensation, and vesting schedules transform key employees into committed long-term partners.
Asset deals are the dominant structure in healthcare M&A — and their tax treatment is often misunderstood by sellers until it's too late to plan. This guide explains how proceeds are allocated and what rates apply.
Every PE-backed healthcare roll-up follows a predictable arc. This paper explains where the PT sector sits on that curve and why the window for top-of-market valuations is finite.
When a buyer approaches you directly, they believe they can acquire your business below what a competitive process would establish. This paper explains the valuation gap between direct offers and auction outcomes.
Long-term capital gains deferral is one of the most powerful post-sale tools available to PT practice owners. This guide covers Opportunity Zone investments, 1031 exchanges, and structured deferral strategies.
The PT/PTA staffing model is one of the most underutilized levers for margin improvement in outpatient rehab. This paper explains how to structure teams, manage supervision ratios, and grow revenue per visit.
The proceeds from your practice sale are only the beginning. This paper walks through how compounding works on a liquidity event and what allocation strategies maximize long-term wealth.
Hospital Outpatient Department contracts offer significantly higher reimbursement rates — but come with compliance obligations most PT owners don't anticipate. This paper maps the full landscape.
Why margins are shrinking across outpatient rehab — and what operators can do to protect EBITDA before going to market. This paper identifies the rate, cost, and staffing pressures most owners underestimate.
How the IRS requires purchase price to be allocated across asset classes in an acquisition — and the significant tax impact on both buyer and seller that most practitioners underestimate.
How short-term rental real estate generates passive losses that can offset ordinary and capital gains income — a powerful but underutilized tool for PT practice owners post-sale.
A framework for allocating liquidity event proceeds across reinvestment, tax mitigation, and long-term wealth preservation — including the common mistakes sellers make in the first 12 months after close.
The questions every PT practice owner should ask before retaining M&A counsel — including red flags, fee structures, and what separates a healthcare M&A specialist from a generalist.
The difference between Medicare's 8-minute rule and the rule of 8s — and why systematic billing errors are one of the most common deal-killers identified during due diligence chart audits.
How to evaluate new clinic locations using demographic data, competitor density, referral source mapping, and payer mix analysis — the same methodology Mihama uses when advising buyers on expansion.
Compensation structures, culture signals, and equity tools that reduce clinician turnover before and after an acquisition — the single biggest operational risk buyers flag during management calls.
Strategies for securing higher reimbursement rates from commercial insurers — including the leverage points most practices never use and how payer concentration risk affects your valuation at close.
Not every deal is a full sale. This paper examines the minority equity model — how it's structured, what a fair market salary looks like alongside distributions, and how PTs use rollover equity to participate in future upside.
How dilution works in JV arrangements, what to watch for in operating agreements, and how to protect your ownership stake when a partner brings in outside capital or additional investors.
With the 2026 conversion factor at $33.40, how you structure PT/PTA teams directly determines your EBITDA. This paper covers supervision ratios, the differential payment rule, compliance exposure, and how buyers scrutinize PTA utilization during due diligence.
Most RIAs charge 1% of AUM annually — on proceeds that could compound for decades. This paper explains how to evaluate fee models, what fiduciary vs. suitability standards mean for your money, and the questions every seller should ask before signing an investment management agreement.
Passive billing behavior is one of the most common and least visible value leaks in PT practices. This paper gives owners a tactical framework to audit RCM performance, identify underperformance, and protect collection rates before going to market.
The management call is where buyers decide whether they trust you — and whether they'll hold their offer. This primer covers what buyers are listening for, how to frame your practice narrative, and the questions that almost always come up.
Your front desk determines your collection rate, patient retention, and first impression — all three of which buyers examine. This guide covers intake, insurance verification, scheduling, and the operational standards that signal a well-run practice during due diligence.
MIPS scores affect your Medicare reimbursement by up to ±9% — and poor performance is visible to buyers during due diligence. This paper explains the four performance categories, scoring benchmarks, and how to maximize your composite score before going to market.
MVA cases carry higher reimbursement than commercial insurance — but require lien agreements, state-specific rules, and billing workflows most PT practices get wrong. This paper covers how auto liens work, how to get paid, and the 2026 state-by-state rules.
Signed into law July 4, 2025, the OBBBA contains significant Medicaid and Medicare provisions affecting outpatient PT practices. This paper explains what changed, what's at risk for practice valuations, and how buyers are pricing OBBBA exposure into their offers.
State courts are increasingly unwilling to enforce broad non-competes — and what you can't enforce, buyers can't rely on post-close. This state-by-state guide covers enforceability standards, geographic and duration limits, and how to draft agreements that hold up.
Complete the form below and we'll send the document directly to your inbox.
Whether you are ready to sell today or simply want to understand what your practice is worth in the current market—we are here for that conversation. No commitment, no pressure, no fee unless a deal closes on terms you are proud of.