How Four Pines Physical Therapy went from payroll worries to a partnership with U.S. Physical Therapy
Founder Norene Christensen built an unprofitable practice into three Wyoming clinics with MHA, then chose her partner from ten acquirers in under four months.
A strong clinician running an unprofitable business
Four or five years after opening, Norene could not find the money for payroll and payroll taxes. She tracked three numbers: charges, visits and new patients. She met Paul Martin at a Private Practice Section conference and hired MHA, despite the cost, because she did not believe the business would survive without help.
Four findings on day one
The wrong hire
One employee was working against the culture. Paul flagged him, and he gave notice the next day.
Billing not built to collect
Billing practices were not set up for efficient collections. MHA streamlined them.
No payment at time of service
Patient payments were not collected at the visit. They are now.
No dashboard
Three numbers were the whole view. MHA built financial and KPI dashboards.
Three numbers to a business run on KPIs
Through COVID, Four Pines lost two therapists, both already planning to leave, then grew faster than before.
Grow first, then exit on her terms
Assessment
Outside-In Assessment: team interviews, billing, registration and collections.
Exit planning
The plan for where she wanted to go, and when.
Early offer declined
An acquirer approached directly. With MHA, she walked away.
Partnership
After a competitive process, Four Pines partnered with U.S. Physical Therapy.
Ten acquirers, one partner, under four months
The acquirer she turned down came back five years later, impressed with what she had built, and won the process. MHA organized the data room, so diligence was time-consuming but straightforward. Nothing changed for her therapists.
Every acquirer at the table was chosen for fit with her culture and goals. The final choice was hers.
What other owners can take from it
Systems before the sale
The dashboards and leadership team that fixed payroll also made Four Pines attractive to acquirers.
Saying no is a strategy
Declining an early, direct offer kept her leverage. Five years later, the same buyer came back singing a very different tune.
Records shorten diligence
Years of organized P&Ls, legal and EMR files are a large part of why it closed in under four months.
“I almost felt like I had this shield of protection, knowing that they were in my court, and they weren't going to let me make a bad decision. As scary as it was to spend the initial investment, the ROI has been amazing.”
A real client engagement, shared with Norene Christensen's permission. Quotes are from her interview, lightly edited for length.
About the Four Pines transaction
Who acquired Four Pines Physical Therapy?
Four Pines Physical Therapy partnered with U.S. Physical Therapy (USPh) in February 2025. Martin Healthcare Advisors advised founder Norene Christensen on the transaction.
How long did the Four Pines transaction take?
Less than four months from the first discussion to closing. Norene had kept years of financial, legal and EMR records, and MHA organized them into a data room for acquirers.
How did MHA choose the acquirers?
MHA hand-picked 10 acquirers that fit Norene's culture and goals, then helped her narrow them to four, then two. The final choice was hers.
What did the Outside-In Assessment find?
A team member working against the culture, billing not built for collections, no payment collected at the time of service, and no financial or KPI dashboards.
Did anything change for the therapists after the partnership?
No. In Norene's words, nothing has changed for her therapists.
Where would a team in your corner take your practice?
