At a glance
A founder-scale clinic needs roughly $216,000 before opening
For a New Hampshire statewide planning model, an independent owner-operated outpatient orthopedic physical therapy clinic in a leased 1,800-square-foot second-generation medical/office suite needs about $216,000 of founder cash at the Typical scope, with a practical $119,000 – $372,250 Lean-to-Premium range. The stabilized Base case is 350 completed visits a month, about $47,600 monthly revenue, $9,770 normalized passive-owner cash operating profit, and $19,720 working-owner pre-tax business cash benefit. The largest caveat is reimbursement and collection timing: signed payer contracts, credentialing, patient mix and the final lease can move the model more than the state filing fees.
Configuration fingerprint. The same founder-scale concept is held constant for interstate comparability: one independent unit; ordinary single-member New Hampshire LLC for the fee model; one leased 1,800 SF site; one owner PT, one employed full-time PT and 0.75 FTE medical admin; five clinic days per week; practical capacity of 430 completed visits per month; orthopedic/musculoskeletal evaluations and follow-up treatment; no pool, imaging or DME retail. Two PTs at roughly 9.9 completed visits per clinician-day over 21.7 clinic days create the capacity ceiling.
The fee model uses an ordinary LLC because New Hampshire's professional-LLC definition in RSA 304-D:1 enumerates qualifying professions and statutes but does not list the physical-therapy statute, RSA 328-A. That is a planning assumption, not entity-structure advice; confirm the permitted entity name and ownership structure with the Secretary of State, OPLC and qualified counsel before filing.
Startup scope
The lease, fit-out and ramp reserve drive New Hampshire opening cash
A second-generation medical or office suite keeps this concept founder-scale, but accessibility, treatment-room layout, electrical work, privacy, plumbing surprises and landlord scope can still create a wide build-out range. The Typical case therefore separates permanent project uses from the cash reserve needed to survive insurance collections during ramp-up.
| Use of funds | Lean | Typical | Premium |
|---|---|---|---|
| Refundable deposit + first month | $4,000 | $6,500 | $10,000 |
| Fit-out, accessibility + tenant improvements | $25,000 | $65,000 | $130,000 |
| Clinical equipment + furnishings | $20,000 | $35,000 | $65,000 |
| IT, EHR, security + setup | $5,000 | $10,000 | $18,000 |
| Licensing, credentialing, legal + accounting | $6,000 | $11,500 | $20,000 |
| Insurance + utility deposits | $2,500 | $4,500 | $7,500 |
| Pre-opening payroll + training | $6,000 | $10,000 | $18,000 |
| Branding, launch marketing + opening supplies | $6,500 | $13,500 | $23,750 |
| Opening operating-cash reserve | $35,000 | $45,000 | $55,000 |
| Contingency | $9,000 | $15,000 | $25,000 |
| Total project cost / founder cash required | $119,000 | $216,000 | $372,250 |
No debt, grant, landlord allowance or equipment financing is assumed, so total project cost, founder cash required and peak interim founder funding are the same. The Typical $216,000 bridge is $110,000 of fit-out/equipment/IT, $39,500 of pre-opening professional/insurance/payroll/launch uses, $6,500 of refundable occupancy cash, $45,000 of unrestricted reserve, and $15,000 contingency. The deposit and reserve are cash uses, not operating expenses. Initial net working capital is $0 because supplies/prepaids are shown separately and the insurance-receivable build is captured in the cash schedule rather than counted twice.
The reserve comes from a working-owner ramp of 180, 230, 280, 320, 340 and 350 visits in months 1 – 6. With 15% self-pay collected immediately and insured claims modeled 25% current-month / 75% next-month, plus a $6,000 monthly owner draw, cumulative cash burn reaches about $28,154 in month 2. Adding a $15,000 minimum closing-cash floor gives $43,154; the plan rounds up to $45,000. First-year post-opening gross cash disbursements are about $329,333 of working-owner operating costs plus $9,000 maintenance capex before owner tax, debt or discretionary distributions; patient receipts fund most of those outflows, so they are not an additional startup-cost total.
Licensing and location
New Hampshire licenses the clinicians; the final address licenses the occupancy
State formation is only the first gate. Physical therapy is regulated under RSA 328-A: a licensed PT is fully authorized to practice physical therapy and must refer when a condition is beyond scope or PT is contraindicated. A business may use physical-therapy terminology only when services are provided by or under the direction of a New Hampshire-licensed PT.
| Requirement | Level | Fee / cadence | Dependency | Official source |
|---|---|---|---|---|
| LLC formation + annual report | State | $100 formation; +$2 online handling; $100 annual report | Form entity before EIN, bank and payer files. | NH Secretary of State |
| Physical therapist license | State | $110; 2-year duration under adopted OPLC fee table | OPLC checklist includes education, FSBPT, jurisprudence, verifications when applicable and FBI history check. | OPLC PT checklist |
| EIN / federal employer tax ID | Federal | $0 from IRS | Obtain after entity formation; needed for employees and federal tax administration. | IRS EIN guidance |
| Workers' compensation | State | Carrier quote required | Coverage responsibility begins before hiring; Lab 303.10 defines employers around one or more employees subject to compulsory coverage. | NH Labor rules |
| NH business taxes | State | BPT 7.5%; BET 0.55% where applicable | For tax periods beginning in 2025, DRA lists $109,000 BPT and $298,000 BET filing thresholds; tax base differs from book revenue. | NH DRA business taxes |
| Medicare enrollment when participating | Federal | Not modeled; confirm current enrollment requirements | CMS identifies PTs in private practice among CMS-855I suppliers; group/clinic structure may also require organization enrollment/reassignment. | CMS enrollment |
| HIPAA privacy/security when covered | Federal | No permit fee | A provider is a covered entity when it transmits standard health transactions electronically; billing vendors may be business associates. | HHS HIPAA |
| Self-pay good-faith estimates | Federal | No permit fee | Uninsured/self-pay patients usually must receive a good-faith estimate; bills at least $400 above an estimate may qualify for dispute. | CMS patient billing rights |
| Zoning, fit-up, building/fire + occupancy | City / county | Varies by city/county | Confirm use before lease commitment; permits and inspections depend on final address and construction scope. | Issuing local authority |
New Hampshire does not have a general sales and use tax, so the Base professional-service model does not collect a general transaction tax. That does not eliminate business-income/enterprise-tax filings, payroll obligations or specialty taxes that could arise if the concept changes. The clinic also needs professional liability, general liability, cyber/privacy and property coverage; exact limits and premiums require carrier quotes and payer/lease review.
Local variation and address checks
Local rules cannot be averaged into a statewide law. These examples establish the range of address-dependent review only; confirm the selected parcel, prior use, accessibility work, signs, fire systems and certificate-of-occupancy requirements before committing nonrefundable capital.
The Building Division handles plan review, building/electrical/heating/plumbing/sign permits, zoning administration, inspections and certificates of occupancy. Commercial CO requests are stated as needing advance scheduling.
The city says zoning should be checked before signing a lease, a Tenant Fit-Up application is required for businesses, and the CO follows completed inspections.
The city's portal covers building, fire and conditional-use permitting, illustrating how local review categories vary even when the state professional license is the same.
The occupancy planning basket uses three comparable small medical/office asking rents reviewed August 2026: Manchester, 1,495 SF at $23.00/SF/year; Concord, 1,549 SF at $18.00/SF/year; and Keene, 1,300 SF at $18.46/SF/year. The median is $18.46/SF/year; applied to 1,800 SF it equals $2,769/month, plus a modeled $431 allowance for pass-through and lease-structure differences = $3,200/month. Asking rents are observations, not executed leases.
Critical path
Payer files and site approvals create a 10 – 18 week launch path
The sequence is dependency-aware rather than additive. Entity, insurance, payer applications, EHR setup and recruiting can overlap; opening still waits for licensed clinicians, lawful occupancy, privacy/billing controls and a staffed schedule. Where an agency or payer does not publish a processing SLA, the duration below is a modeled planning range rather than an official promise.
File the LLC, obtain EIN, bank account and core ownership documents. Payer and vendor files depend on consistent legal data.
Confirm PT/medical office use, accessibility, parking, signs, landlord scope and permit path. Negotiate contingencies before major deposits.
Submit clinician, group and reassignment files as applicable. Medicare uses CMS enrollment pathways; commercial timing varies by payer.
Run plans, permits, construction, IT, privacy controls and equipment purchasing in parallel where dependencies allow.
Bind workers' comp before employees, complete EHR/billing workflows, verify clinician licenses and rehearse patient intake.
Close permit items, confirm occupancy, payer effective dates, good-faith-estimate workflow, cash-pay policy and claims transmission.
Operating economics
At 350 visits a month, the statewide Base case produces $47,600 revenue
Revenue is modeled from completed visits, not from a vague annual industry average. Base capacity is 430 visits/month. At 350 visits, utilization is 81.4%, equal to roughly 8.1 completed visits per PT per clinic day. Revenue is net operating revenue after contractual adjustments, refunds and credits; pass-through taxes are excluded.
350 completed visits × $136 weighted net collection per visit = $47,600/month = $571,200 stabilized annual revenue.
The $136 Base collection assumption uses 55% commercial/auto/workers' compensation at $143, 30% Medicare/Medicare Advantage at $116, and 15% self-pay at $150. Contracted net rates must be validated. As market anchors, Excel Physical Therapy and Portsmouth Physical Therapy each publish a $200 initial evaluation and $150 follow-up rate, while NH HealthCost reports a statewide median cost of $87 per 15-minute therapeutic-exercise unit and $232 for a low-complexity evaluation. Those are patient price/cost observations, not the clinic's net payer reimbursement.
| Metric | Downside | Base | Upside |
|---|---|---|---|
| Completed visits | 260 | 350 | 420 |
| Capacity utilization | 60.5% | 81.4% | 97.7% |
| Net collection / visit | $122 | $136 | $143 |
| Monthly revenue | $31,720 | $47,600 | $60,060 |
| Normalized passive-owner cash operating profit | – $2,538 | $9,770 | $19,442 |
| Working-owner pre-tax business cash benefit | $5,365 | $19,720 | $30,984 |
For cash planning, 15% of revenue is treated as self-pay collected in the service month. The insured 85% is modeled as 25% collected in the current month and 75% in the next month. That lag is deliberately separate from earned revenue. The first-year ramp therefore earns about $516,800, below the $571,200 stabilized annual run rate even though the clinic reaches Base volume by month 6.
Cost structure
New Hampshire clinical labor is the margin line to watch first
BLS May 2023 New Hampshire OEWS reports mean annual pay of $95,220 for physical therapists and $44,170 for medical secretaries/administrative assistants. Normalizing those figures with Northeast CPI-U from 312.241 in May 2023 to 349.414 in July 2026, a 1.1191 factor, gives about $106,600 and $49,400 before payroll burden.
The model adds a 12% payroll burden. Of that, 7.65 percentage points reflect the 2026 employer Social Security and Medicare rates of 6.2% and 1.45%; the rest is a planning allowance for unemployment, workers' compensation and modest paid-time/admin burden. It excludes a rich health-benefit package, so employers needing stronger recruiting benefits should increase labor cost.
| Cost line | Monthly | % revenue |
|---|---|---|
| Billing / clearinghouse · 5.2% | $2,475 | 5.2% |
| Payment processing · 0.7% | $333 | 0.7% |
| Supplies / laundry · 2.2% | $1,047 | 2.2% |
| Patient bad debt · 1.5% | $714 | 1.5% |
| Employed PT, fully loaded | $9,950 | 20.9% |
| 0.75 FTE medical admin, fully loaded | $3,460 | 7.3% |
| Rent / CAM planning allowance | $3,200 | 6.7% |
| Utilities + business insurance | $1,600 | 3.4% |
| EHR / IT + marketing + cleaning / maintenance / professional admin | $5,100 | 10.7% |
| Owner replacement labor, variable clinical + fixed management | $9,950 | 20.9% |
| Normalized passive-owner cash operating costs | $37,830 | 79.5% |
The owner replacement wage is split by behavior: $7,960/month is variable direct clinical replacement labor at Base volume and $1,990 is fixed management/administration replacement labor. The employed PT salary is treated as step-fixed inside the current two-PT capacity band: it does not decline when the schedule has a weak week. Debt principal, interest, income tax and depreciation are not operating expenses here. The Base case has no debt; a $750/month maintenance-capex reserve sits below operating profit.
Labor risk
A 5% loaded-pay increase for the two PT roles costs roughly $995/month before any admin benefit change. Watch clinician vacancy days, overtime coverage and visits per clinician-day.
Collection risk
A $5 drop in net collection per visit reduces Base monthly revenue by $1,750 with little immediate relief in salaried payroll or rent.
Occupancy risk
Every additional $5/SF/year on 1,800 SF adds $750/month. Confirm gross-versus-NNN structure and pass-throughs before using an asking rate.
Owner economics
Owner labor and residual clinic profit are two different returns
The working-owner view should not disguise labor as profit. The Base model first charges the clinic for a fully loaded replacement PT/manager, producing normalized passive-owner cash operating profit. The working owner then adds back only that same avoided replacement cost. Owner draws are distributions of cash, not operating expenses.
Passive-owner cash operating profit. $47,600 revenue less $37,830 normalized cash operating costs, including full owner replacement labor.
Imputed owner labor avoided. The economic value of the working owner's clinical and management work, not an additional accounting profit.
Working-owner pre-tax business cash benefit. Labor value plus residual return before debt, maintenance capex, tax and future working-capital needs.
After the $750 monthly maintenance-capex reserve, Base cash potentially available before income/business-tax planning and additional working-capital needs is about $9,020/month on a passive basis or $18,970/month for the working owner. Depreciation and amortization are not supported with a detailed asset schedule, so the article does not fabricate EBIT or EBITDA. New Hampshire BPT/BET exposure also depends on taxable bases and entity facts, so those taxes remain below this operating comparison rather than being treated as a simple percentage of revenue.
Unit economics and break-even
Passive break-even is about 253 visits a month – well below modeled capacity
The natural unit is one completed visit. Within the current staffing band, billing, processing, supplies, bad debt and the owner's variable clinical replacement time move with volume. Rent, the employed PT salary, admin payroll and owner management replacement labor are fixed or step-fixed until the clinic changes capacity.
| Metric / formula | Base result |
|---|---|
| Revenue per completed visit | $136.00 |
| Variable non-owner cost per visit · 9.6% | $13.06 |
| Variable owner clinical replacement labor / total clinic visit | $22.74 |
| Passive/economic contribution per visit | $100.20 |
| Passive/economic contribution margin | 73.7% |
| Cash contribution before owner compensation | $122.94 |
| Cash-survival break-even · $23,310 ÷ 90.4% | $25,785 · 190 visits |
| Passive break-even · $25,300 ÷ 73.7% | $34,340 · 253 visits |
| Sustainable working-owner break-even · ($23,310 + $9,000 target pay) ÷ 90.4% | $35,741 · 263 visits |
Runway is modeled from cash receipts and disbursements rather than reserve divided by an average burn. The $45,000 opening reserve bottoms near $16,846 in month 2 after the modeled owner draw, then recovers as collections catch up; it stays above the $15,000 minimum-cash floor through the 12-month model, so no additional funding is required in that horizon. A slower payer mix or delayed contract effective date can reverse that result quickly.
Primary payback: 27 months, passive-owner, unlevered project basis, pre-tax. To avoid counting the ramp twice, the month-0 project investment in that schedule is $171,000 – the Typical project uses excluding the separately prefunded $45,000 loss reserve – and then actual monthly ramp cash deficits/positive cash are recorded period by period, including $750/month maintenance capex and the insurance collection lag. Cumulative capital-provider cash first turns positive in month 27. Because there is no modeled debt and no specified reserve-release/distribution policy, a separate founder-equity distribution payback is not claimed.
State market and sensitivity
New Hampshire demand is measurable, but PT-only market revenue is not
A reliable state-market amount is not publicly determinable from the available category data without mixing physical therapy with adjacent rehabilitation services or inferring payer revenue from broad national ratios. This model therefore does not manufacture TAM. It uses demand and supply proxies, then lets the future address-level trade area validate whether 350 monthly visits are realistic.
1,415,342 residents
Census QuickFacts estimates New Hampshire's July 1, 2025 population at 1,415,342, up 2.7% from the 2020 estimate base.
23.0% age 65+
The same QuickFacts profile reports a relatively large older-adult share, a useful demand proxy for mobility and musculoskeletal care but not a revenue estimate by itself.
1,300 PT jobs
BLS May 2023 OEWS estimated about 1,300 physical therapists statewide. Employment is a supply/workforce proxy, not clinic receipts or patient demand.
The most sensitive operating variables are net collection per visit, completed-visit volume, clinical labor and occupancy. At Base volume, every $5/visit reimbursement move changes revenue by $1,750/month. Ten additional completed visits at $136 add $1,360 revenue before variable costs and owner clinical replacement labor. A $1,000 monthly increase in fixed occupancy or payroll requires roughly $1,357 more passive-basis revenue at a 73.7% contribution margin, or about ten additional Base-price visits.
- Payer-rate risk → revenue per visit. Track allowed amount and cash collected per completed visit by payer, plus denial and write-off rate.
- Schedule risk → volume/utilization. Track completed visits per PT-day, cancellation/no-show percentage and new-patient conversion.
- Clinical labor risk → payroll and capacity. Track loaded labor per visit, vacancy days and whether the owner is carrying excess clinical hours.
- Lease/build-out risk → startup cash and fixed overhead. Track final all-in occupancy $/SF, landlord scope, permit status and contingency consumption.
- Collection lag → reserve and runway. Track days in A/R, clean-claim rate and cash collections against earned revenue rather than assuming invoices equal cash.
Sources and method
What is observed, what is official, and what still needs a local quote
Research was reviewed August 29, 2026 and expressed on a 2026 USD planning basis. Official fees and rules use issuing authorities; wages use New Hampshire OEWS normalized to July 2026 with Northeast CPI-U; occupancy uses a three-market in-state asking-rent basket; reimbursement, build-out, equipment, insurance and utilization remain modeled assumptions requiring contracts or quotes.
| Source / publisher | Geography / period | Evidence type | How used |
|---|---|---|---|
| NH RSA 328-A | NH · current statute | Official rule High | Practice authority, title restrictions, referral duty and display requirements. |
| NH OPLC fee rules + checklist | NH · current adopted fee table | Official fee/rule High | $110 PT license fee, two-year duration and application inputs. |
| NH Secretary of State | NH · current | Official fee High | LLC formation, online handling and annual-report fees. |
| NH Department of Revenue Administration | NH · 2025+ thresholds | Official tax rule High | BPT/BET rates and filing thresholds; no general sales-tax context. |
| NH Department of Labor rules | NH · current | Official rule High | Employer definition and pre-hire workers' compensation gate. |
| IRS Publication 15 + EIN guidance | U.S. · 2026 | Official federal High | Employer FICA rates and EIN administration. |
| Source / publisher | Geography / period | Evidence type | How used |
|---|---|---|---|
| CMS enrollment + patient billing rights | U.S. · current | Official federal High | PT private-practice enrollment path and good-faith-estimate gate. |
| HHS HIPAA | U.S. · current | Official federal High | Covered-entity trigger for electronic standard transactions. |
| BLS New Hampshire OEWS | NH · May 2023 | Government data High | PT/admin wages and PT employment. |
| BLS Northeast CPI-U | Northeast · May 2023 – Jul 2026 | Government data Moderate | 1.1191 wage price-basis normalization; regional, not NH-only. |
| U.S. Census QuickFacts | NH · 2025 estimate | Government data High | Population, growth and older-adult demand proxies. |
| NH HealthCost + in-state rent observations | NH · current / Aug 2026 basket | Published benchmark + observed quotes Moderate | PT price context and three-market medical/office rent basket. |
Evidence confidence is highest for formation fees, state/federal rules and published government data. It is moderate for CPI-normalized wages and the three-listing occupancy basket because those require adjustment or observed-market interpretation. It is model-dependent for reimbursement, build-out, insurance, clinical utilization and collection timing; those inputs should be replaced with payer contracts, contractor bids, lease terms and carrier quotes before financing or signing a long lease.
The largest uncertainty is not the professional-license fee. It is the combined effect of payer mix, credentialing effective dates, net collection per visit, clinician recruiting cost and the final suite's all-in occupancy/build-out burden. Confirm the exact operating address and every issuing jurisdiction before committing capital; this article is a planning model, not legal, tax or reimbursement advice.