Mihama Acquisitions is the investment bank for outpatient PT, OT, and ST practice owners. We run competitive auction processes that consistently produce above-market outcomes—with full confidentiality from start to finish.
Mihama Acquisitions is the investment bank for outpatient PT, OT, and ST practice owners. Different industries carry different nuances — and different valuations. A generalist advisor will treat your practice the way they would treat a roofing deal; we never will.
Understanding the dynamics of rehab services makes a far bigger difference than most owners expect. That fluency lets us defend your valuation and advise across the details that actually move it — compliance, revenue optimization, scheduling and staffing, and the operational levers buyers scrutinize most.
We represent private practices across the country — and on any deal, only one side of the table. A well-run competitive process, executed with full confidentiality, consistently produces better outcomes than direct negotiation — proven across more than 250 closed transactions in 46 states.
We advise only in outpatient PT, OT, and ST — the single market we have ever served. We know your payor mix, referral dynamics, and buyer universe cold.
On any given deal we represent only one side — never both. No divided loyalty and no conflict of interest, so our incentives stay fully aligned with yours.
250+ practices represented across 46 states, with a network of 200+ institutional and strategic buyers competing for quality clinics.
We put our money where our mouth is: no retainer, no break-up fee. Walk away at any stage and you owe us nothing. We succeed only when you do.
Mihama runs the process — but every decision stays yours. A blind, two-phase auction creates genuine competition among institutional buyers, while you keep control at each stage: how your practice is presented, who is invited, who wins, and whether you ever sign.
You decide how your practice goes to market. We prepare the confidential memorandum, anonymous teaser, and secure data room — and you approve every word, every figure, and exactly what the data room reveals before a single buyer sees it. Your name stays sealed until you say so.
You decide who is invited in. We assemble and pressure-test a field of 200+ strategic and financial buyers; you approve who is included and who is not. Every call and visit happens under NDA, after hours, on your terms — never visible to your staff or patients.
You decide who wins — or that no one does. Buyers submit their best and final offers simultaneously, and you choose the partner on valuation, structure, and fit. Competition creates the leverage; the decision is entirely yours.
You decide whether it proceeds. We manage the 90–120 day process — defending your EBITDA and steering compliance and quality-of-earnings reviews — but at every checkpoint, the call to continue, renegotiate, or walk away is yours alone.
You decide if you close. Nothing is binding until you sign the Definitive Purchase Agreement. We coordinate financing, leases, and every detail through wire day — the deal happens only when, and because, you choose it.
A selection of the platforms, PE-backed groups, and strategic operators in our active buyer network.
After more than two years of direct negotiations with an institutional buyer that yielded no meaningful progress—despite repeated commitments to a future partnership—Hand Therapy of Wyoming engaged Mihama to run a structured process and identify a more suitable partner.
Within five weeks of launching a targeted blind auction, Mihama secured six letters of intent from qualified buyers. The seller entered exclusive due diligence shortly thereafter, ultimately closing with a best-fit strategic partner at a valuation that substantially exceeded the terms previously offered through direct negotiation.
Throughout the process, Mihama provided strategic support across organizational restructuring, SBA financing challenges, and lease reassignment logistics—while keeping the entire transaction confidential from staff and referral sources through closing day.
Mihama regularly competes in the same market as Wall Street-advised transactions—deals involving practices many times the size of those we typically represent. Our blind auction process has consistently produced multiples that are competitive with, and in many cases comparable to, those achieved in significantly larger, institutionally-backed deals. Scale is not the only path to a strong outcome. Process is.
From start to finish, Mihama was impressive to say the least. They absolutely made our dreams a reality by partnering us with the best fit for our clinics. If you choose Mihama, you will not be disappointed.— Anni Stafford, Owner · Hand Therapy of Wyoming
“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
In their own words — from the sellers who have been through it.
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.
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