From Bookkeeping to Cash-Based PT: How Michele Mannino Built Summit PT and Performance

Not every physical therapist dreams of owning a clinic.

Some clinicians spend years working in traditional outpatient settings before realizing they want something different. Others know they want to start a business but struggle to figure out how to make the transition.

And then there are people like Michele Mannino.

Michele had a business degree, experience in marketing, and a background in bookkeeping before becoming a physical therapist.

On paper, she seemed like someone who would naturally gravitate toward entrepreneurship.

But starting her own physical therapy practice wasn't part of her original plan.

In fact, she was perfectly happy with the idea of working part-time as a PT while running a small bookkeeping business on the side.

Today, Michele owns Summit PT and Performance in Stowe, Vermont, a growing cash-based physical therapy practice serving active adults, outdoor enthusiasts, and athletes.

Her business has expanded through multiple locations, added specialized clinicians, and developed ongoing training services that help patients continue progressing after traditional rehabilitation.

She's also exceeded an ambitious annual revenue goal with several months remaining in the year.

In this episode of the PT Entrepreneur Podcast, Courtney Morse sits down with Michele to discuss her unconventional career path, how she built Summit PT and Performance, and the decisions that helped her grow a practice around the type of patients and work she genuinely enjoys.

Her story is a reminder that you don't need to have everything figured out before starting a cash-based PT practice.

You just need to recognize an opportunity, take action, and keep improving along the way.

Why Michele Didn't Initially Plan to Become a Physical Therapist

Michele's career began in a completely different field.

She earned her undergraduate degree in business and moved to California after graduation.

Along with three friends, she packed into a 1997 Jeep Cherokee and drove across the country.

They spent about a month traveling before eventually settling in San Diego.

Michele began working in sports marketing.

It sounded like an ideal career.

She had a business degree, enjoyed sports, and was working in an industry that aligned with her interests.

But after only a few months, she realized she didn't enjoy spending her days behind a desk.

The job that looked perfect on paper wasn't particularly fulfilling in practice.

So she started exploring another direction.

Michele earned her personal training certification and began working at a gym in San Diego, helping clients with fitness while also working in membership sales.

That experience helped her discover what she enjoyed about working directly with people.

She liked helping clients improve their physical abilities.

She enjoyed the fitness environment.

And she became increasingly interested in understanding injuries, rehabilitation, and the process of returning people to their favorite activities.

Physical therapy had always been somewhere in the back of her mind.

Growing up, Michele played soccer and experienced multiple injuries, including ACL tears.

Those experiences exposed her to rehabilitation early in life.

Eventually, she decided to pursue physical therapy as a career.

Taking the Long Route to PT School

Changing careers wasn't as simple as applying to graduate school.

Michele already had a bachelor's degree in business, but that didn't mean she had the science prerequisites required for a physical therapy program.

She needed to complete additional coursework before she could even apply.

After spending approximately a year in California, she returned to Vermont to be closer to family.

She then spent roughly one to two years completing prerequisite courses, many through a local community college.

It was a significant investment of time before her formal PT education even began.

But the experience also gave Michele something many clinicians don't have when they enter the profession.

She had already spent time in another industry.

She understood basic business concepts.

And she had firsthand experience working with clients in a fitness setting.

Those skills would eventually become valuable when she started her own practice.

Michele graduated from the University of Vermont's physical therapy program in 2014.

And although entrepreneurship wasn't on her radar yet, she was beginning to develop a clear picture of the kind of clinical environment she enjoyed.

The Traditional PT Clinic That Influenced Her Future Business

After graduating, Michele accepted a position at the same physical therapy clinic where she completed her final clinical rotation.

She worked there for approximately four years.

Unlike many practice owners who leave traditional outpatient physical therapy because of an immediately negative experience, Michele genuinely enjoyed this job.

The clinic had an environment she loved.

It featured open space, turf, rubber flooring, large windows, and a strong connection to exercise and movement.

It felt more like a training facility than a traditional medical office.

Just as importantly, Michele enjoyed the people she worked with.

The clinicians had strong relationships, and the team culture made the workplace enjoyable.

Those details stayed with her.

Years later, when Michele opened Summit PT and Performance, she wanted to recreate many of those same qualities.

She wanted an inviting, gym-like environment.

She wanted clinicians who enjoyed working together.

And she wanted patients to feel comfortable continuing their physical development beyond simply recovering from an injury.

There's an important lesson here for aspiring clinic owners.

You don't have to reject everything about traditional physical therapy to build a better practice.

Sometimes your previous experiences show you exactly what you want to preserve.

The goal is to identify what works, recognize what doesn't, and build a business that reflects your priorities.

How a Long Commute Led Michele Toward a Different Career

Michele eventually moved farther away from the clinic.

She and her family purchased land outside Stowe, Vermont, leaving her with a commute that could become especially challenging during the winter.

On a good day, the drive might take less than an hour.

But Vermont winters aren't always predictable.

Snow and traffic could turn the commute into a trip lasting two hours or more.

After dealing with that for a while, Michele decided to find something closer to home.

She accepted a position at a local hospital-based outpatient orthopedic clinic.

The shorter commute was an improvement.

But the work itself presented a different challenge.

Michele found that she wasn't particularly energized by the patient population.

Some patients were attending therapy because their physician required it.

Others weren't especially motivated to participate in their rehabilitation.

And Michele struggled with the feeling that she was investing significant effort into helping people who weren't equally invested in their own progress.

Meanwhile, the patients she enjoyed treating most were active adults, runners, and people working toward specific physical goals.

Those were the appointments she looked forward to.

She enjoyed helping someone return to running, hiking, skiing, or another meaningful activity.

But in the traditional model, treatment often ended when the patient was no longer experiencing pain.

Michele felt like that was sometimes the point when the most interesting work could begin.

She wanted to help people build strength, improve performance, and develop the capacity to do more than they could before their injury.

That disconnect gradually contributed to burnout.

She wasn't necessarily tired of being a physical therapist.

She was tired of practicing in a way that didn't align with the work she found most rewarding.

Why Michele Started a Bookkeeping Business Before Opening Her PT Clinic

Michele's solution wasn't initially to start a physical therapy practice.

It was to spend less time treating patients.

A friend who directed a local nonprofit mountain biking organization needed bookkeeping help.

Michele already had experience doing bookkeeping throughout college and PT school as a way to earn additional income.

She had always enjoyed working with numbers.

So she agreed to help.

Then a neighbor who owned an excavation company needed a bookkeeper.

Michele took on that work too.

Before long, she had developed a small bookkeeping business alongside her physical therapy career.

She reduced her clinical hours and began splitting her time between the two.

And for a while, that seemed like an ideal arrangement.

Her goal was simple.

Work approximately 20 hours per week as a physical therapist and another 20 hours doing bookkeeping.

She could continue treating patients without spending her entire week in a clinical setting.

And she could use her business background to generate additional income.

But then she started learning more about cash-based physical therapy.

During a dry needling course, Michele met another physical therapist who was involved in the PT Biz Mastermind.

He encouraged her to consider starting her own practice and introduced her to Danny Matta and Physical Therapy Biz.

Michele began listening to the PT Entrepreneur Podcast and reading Danny's book.

For the first time, she started seriously considering what it would look like to build a physical therapy business around the patients she actually wanted to treat.

The idea gradually became more appealing.

She could work with active adults.

She could spend more time helping people pursue meaningful goals.

And she could create the kind of clinical environment she had enjoyed earlier in her career.

When Michele first spoke with John at PT Biz, she still imagined maintaining her part-time PT and part-time bookkeeping schedule.

She wasn't planning to build a large organization.

But as she began taking action, her vision changed.

Starting a Cash-Based PT Practice With Almost No Overhead

One of the most interesting parts of Michele's story is how simple her practice was in the beginning.

She didn't start by leasing a large commercial facility.

She didn't purchase expensive equipment.

And she certainly didn't have a fully developed administrative system.

Her first patient lived approximately 45 minutes away.

Michele drove to his home, unfolded a treatment table, and provided care.

At that point, she was still figuring out the basic operational details of running a practice.

She didn't have a sophisticated electronic medical record system or a fully developed payment process.

She was simply finding ways to treat patients and build the business.

That first patient eventually became part of a much longer relationship.

Years later, Michele was still treating him and his wife, although they now visited her clinic rather than having her drive to their home.

It's a great example of how valuable those early patient relationships can become.

Your first patients aren't simply appointments on your schedule.

They can become long-term supporters, repeat customers, and referral sources as your practice develops.

And you don't need an impressive facility to begin creating those relationships.

You need to deliver excellent care.

From Mobile PT to Treating Patients Inside a Spin Studio

As Michele continued growing Summit PT and Performance, she moved from mobile visits into a shared fitness space.

Her first physical location was inside a spin studio.

She didn't have a dedicated treatment room available all day.

Instead, she worked around the studio's class schedule.

Between approximately 10 a.m. and 3 p.m., when spin classes weren't taking place, Michele could use the space to treat patients.

She would bring out her folding table and a plastic container filled with treatment tools.

When the studio needed the room again, she packed everything away.

It wasn't glamorous.

But it allowed her to begin establishing a physical presence without taking on the financial commitment of a traditional commercial lease.

This is one of the biggest advantages of starting a cash-based practice with low overhead.

You don't need to immediately create the clinic you envision operating five years from now.

You need a practical environment where you can provide excellent care and begin developing consistent demand.

A shared fitness space can be an effective starting point.

It provides access to people who already value exercise and physical performance.

It can also help you develop relationships with coaches, trainers, and other professionals who serve your ideal patients.

For Michele, it was a natural fit.

She wanted to work with active adults and outdoor athletes.

Being connected to a fitness environment helped reinforce that identity.

Why Your First Clinic Doesn't Need to Be Your Forever Clinic

Eventually, Michele outgrew the spin studio arrangement.

She moved Summit PT and Performance into a dedicated 600-square-foot space inside a gym.

That gave her more consistency and room to expand.

It also created the opportunity to hire her first clinician.

And that first hire introduced a service Michele hadn't originally planned to offer.

Pelvic floor physical therapy.

Michele didn't personally specialize in pelvic health.

But her new clinician did.

Instead of limiting the practice to the services Michele could provide herself, she recognized an opportunity to expand the clinic around her employee's expertise.

That became an important part of how Summit developed.

Michele wanted clinicians to have the freedom to work with the patient populations they were most passionate about, as long as those services aligned with the overall mission of the practice.

Rather than expecting everyone to treat exactly the same patients, she encouraged individual interests and specialties.

That philosophy would eventually help Summit expand beyond general orthopedic rehabilitation.

And it created an important advantage for recruiting and retaining clinicians.

Building a Cash-Based PT Practice Around Active Adults

Stowe, Vermont, is an ideal environment for a physical therapy practice focused on active lifestyles.

The area attracts people who enjoy skiing, mountain biking, hiking, and other outdoor activities.

But Michele doesn't define her ideal patient exclusively as a competitive athlete.

Her core population includes active adults who want to continue participating in the activities they enjoy.

That might be an experienced mountain biker returning from an injury.

It could be a skier preparing for the winter season.

Or it might be someone whose primary goal is completing a comfortable hour-long hike.

The common denominator isn't elite athletic performance.

It's motivation.

These patients want to improve their physical abilities.

They value movement.

And they're willing to participate in the process required to achieve their goals.

That makes them a strong fit for a cash-based model focused on individualized care and long-term outcomes.

Michele also recognized that these patients often need more than a short course of traditional physical therapy.

Getting out of pain is important.

But returning to a favorite activity confidently may require additional strength, conditioning, and ongoing support.

That understanding would eventually influence the services Summit offered.

How Hiring Specialists Helped Summit Expand Its Services

As Summit grew, Michele continued recruiting clinicians with different professional interests.

One clinician had extensive experience treating foot and ankle conditions and creating custom orthotics.

Rather than expecting him to abandon that specialty, Michele invested in the equipment needed to offer custom orthotics at Summit.

Another clinician was passionate about golf.

Michele could certainly treat general orthopedic conditions affecting golfers, but she recognized that someone with a deeper understanding of the sport could offer something different.

That created an opportunity to develop more golf-specific services.

The same principle applied to pelvic floor rehabilitation.

Michele wasn't personally providing those treatments.

But she could build a practice where another clinician had the resources and support to specialize.

This approach created multiple benefits.

First, it allowed Summit to serve a broader range of patients.

Second, it gave clinicians opportunities to develop professionally.

And third, it helped make the practice a more attractive place to work.

For a physical therapist who wants to specialize in a particular patient population, the opportunity to develop that specialty can be incredibly valuable.

They aren't simply filling a treatment schedule.

They're helping shape the services the clinic provides.

A growing cash-based PT practice doesn't have to be built entirely around the owner's clinical interests.

It can grow through the combined strengths of the team.

And as Michele discovered, those individual interests can create new revenue opportunities that weren't part of the original business plan.

Why the Next Stage of Growth Required More Than Physical Therapy

By this point, Summit PT and Performance had evolved considerably from Michele's original mobile practice.

She had gone from driving to patients' homes to treating inside a spin studio, then operating from a dedicated gym space.

She had started hiring clinicians.

And she was beginning to develop a broader range of services.

But another opportunity was emerging.

Michele wanted to create a way for patients to continue improving after completing their initial rehabilitation.

Instead of ending the relationship when someone was out of pain, Summit could help them build strength, maintain progress, and stay connected to the clinic.

That led to the development of small group training.

It also introduced a new business model with the potential to create ongoing recurring revenue.

And it would become one of the most interesting parts of Summit's growth.

How Summit PT and Performance Built Recurring Revenue Through Small Group Training

One of the biggest challenges for cash-based physical therapy clinic owners is figuring out what happens after a patient finishes their plan of care.

You've helped someone get out of pain.

They've returned to running, hiking, skiing, or whatever activity brought them into your clinic.

They're happy with their results.

But that doesn't necessarily mean they're ready to stop improving.

In fact, many patients are just beginning to realize what's possible.

That's where Michele Mannino saw an opportunity at Summit PT and Performance.

Rather than limiting the patient relationship to traditional rehabilitation, Michele and her team developed a small group training program that allows people to continue building strength, improving performance, and staying connected to the clinic.

And it's become one of the most valuable services Summit offers.

Why Small Group Training Makes Sense for a Cash-Based PT Clinic

For many patients, the transition from rehabilitation to independent exercise can be challenging.

They've spent weeks working closely with a physical therapist who understands their injury history, movement limitations, and personal goals.

Then their plan of care ends.

Some patients return to the gym and continue progressing independently.

Others struggle to maintain consistency.

And some simply prefer having professional guidance.

Small group training creates an opportunity to serve those patients without requiring them to continue paying for individual physical therapy sessions indefinitely.

At Summit, the program is led by Brian, one of Michele's clinicians.

The groups are intentionally small, with a maximum of four to six participants.

Each group meets twice per week for hour-long sessions.

That structure provides enough individual attention for participants to receive meaningful coaching while creating a more affordable option than ongoing one-on-one care.

It's also a great example of how a clinic can develop a Stability Layer through recurring revenue.

Instead of relying exclusively on new patients entering traditional plans of care, the business creates an ongoing service that existing patients genuinely value.

That revenue can help make the business more predictable.

And because the participants already know and trust the clinicians, the program builds on relationships that have already been established.

The Retention Numbers Behind Summit's Training Program

When Michele and her team launched the program, they weren't entirely sure how it would develop.

They started with a small group of participants who were willing to try something new.

The response was encouraging.

At the time of the podcast, Summit had two established groups, each with six participants.

Both were full.

And the clinic was preparing to launch a third group on October 1.

But the most impressive part wasn't simply filling the groups.

It was keeping people engaged.

Michele shared that three of the original five participants were still involved more than a year after the program began.

That's meaningful retention for a service that started as an experiment.

And the reasons people stayed went beyond exercise programming.

Participants were seeing progress.

They were getting stronger.

They were accomplishing things they hadn't necessarily expected.

And they were building relationships with the other people in their groups.

Michele described one early-morning group whose members had become close friends.

They enjoyed training together and had developed a sense of community around the program.

That creates something valuable for both the patients and the business.

People aren't simply purchasing exercise sessions.

They're participating in an experience they enjoy and want to continue.

And when a service becomes part of someone's weekly routine, retention becomes much easier.

Why Group Training Can Be One of Your Most Profitable Hours

Small group training isn't just beneficial for patients.

It can also be an attractive financial model for a cash-based PT clinic.

Consider the difference between treating one patient during an hour and coaching a group of six participants.

Courtney discusses potential group training prices in the range of $40 to $60 per person per session.

Those figures are illustrative rather than Summit's confirmed pricing.

But they demonstrate the opportunity.

At $40 per participant, a full six-person group generates $240 for an hour.

At $50 per participant, that increases to $300.

And at $60 per participant, the group generates $360.

That's a substantial amount of revenue for a single hour of service.

Of course, revenue isn't the same as profit.

You still have to account for clinician compensation, facility costs, equipment, and other operating expenses.

But the model can be efficient because one clinician can work with multiple participants simultaneously.

Michele explained that group training had become one of Summit's highest-revenue hours.

There are also operational advantages.

The clinician isn't completing six separate physical therapy notes during that hour.

And the format provides variety compared with treating individual patients throughout the entire day.

That variety can be valuable for employee satisfaction.

Clinicians get to coach, teach, and develop relationships with people in a different setting.

For a practice focused on active adults, the service fits naturally with the clinic's overall mission.

How Recurring Revenue Strengthens the Patient Relationship

Another interesting aspect of Summit's program is that group training doesn't necessarily replace individual physical therapy.

Michele shared that approximately half of the training participants were still receiving one or two individual sessions each month.

Some wanted additional recovery work.

Others needed help addressing a specific issue or refining their movement.

The group sessions provided consistent training.

The individual appointments offered more personalized clinical support when appropriate.

Those services complement each other.

And they create a patient relationship that extends beyond a single episode of care.

This is an important concept for cash-based practice owners.

You don't have to build your entire business around constantly finding new patients.

You can also create services that help existing patients continue progressing.

That doesn't mean everyone needs ongoing treatment.

It means giving people an appropriate next step when they want continued support.

For Summit, small group training has become that next step for many patients.

It supports the business financially while helping participants stay active, build strength, and maintain relationships with the clinicians they trust.

Why Michele's Bookkeeping Background Became a Business Advantage

Michele's background in bookkeeping is unusual among physical therapy practice owners.

And it has provided a meaningful advantage as Summit has grown.

Before opening her clinic, Michele had already spent years working with financial information.

She understood bookkeeping, financial reports, and the importance of maintaining accurate records.

That didn't mean she automatically understood every metric involved in running a successful cash-based PT practice.

She still needed to learn which benchmarks mattered for patient acquisition, conversions, and clinic performance.

But she was comfortable looking at the numbers.

And that made it easier to develop the habit of tracking them consistently.

Many clinic owners avoid this part of entrepreneurship.

They're excellent clinicians.

They enjoy treating patients.

But they don't particularly like reviewing financial statements, tracking key performance indicators, or analyzing business performance.

Michele encourages owners to start developing those habits early.

Even if you don't know exactly which metrics will matter five years from now, having historical data gives you something valuable to work with.

You can identify trends.

You can compare performance across different periods.

And you can make decisions based on evidence rather than assumptions.

Why Tracking Your Numbers Early Pays Off Years Later

One of Michele's biggest recommendations is to avoid waiting until your practice becomes established before organizing your financial information.

She sees clinic owners who hesitate to invest in bookkeeping software or other systems because they're trying to minimize expenses.

Instead, they manage everything through basic spreadsheets.

That approach may work temporarily.

But it can become difficult to maintain as the business grows.

And if the records aren't organized consistently, you may lose valuable historical information.

Michele appreciates being able to look back across approximately five years of business performance.

She can see how revenue has changed.

She can identify seasonal patterns.

And she can evaluate whether a particular challenge is unusual or simply part of the normal business cycle.

That historical perspective can make ownership less stressful.

For example, suppose your clinic experiences a slower August.

If you've only been operating for a few months, that slowdown might feel alarming.

You might wonder whether your marketing has stopped working or whether patient demand is disappearing.

But if you've tracked performance for several years, you may discover that August is consistently slower.

Now the situation looks different.

You aren't necessarily dealing with a new problem.

You're experiencing a predictable seasonal pattern.

And that gives you the opportunity to plan accordingly.

Using KPIs to Make Better Business Decisions

Courtney reinforces this point by discussing how seasonal trends can influence business decisions.

If you know certain weeks are consistently slower, you have options.

You might schedule vacation during those periods.

You could plan a patient reactivation campaign.

Or you could adjust your marketing activities ahead of the anticipated slowdown.

The important thing is that you're making a deliberate decision rather than reacting emotionally.

Michele also emphasizes that tracking KPIs is an ongoing process.

She regularly evaluates which numbers she's monitoring.

Sometimes she adds new metrics.

Other times she stops tracking information that isn't helping her make decisions.

That's a useful distinction.

The goal isn't to create the biggest spreadsheet possible.

It's to identify the numbers that help you understand what's happening inside your business.

For a cash-based PT clinic, those might include new leads, discovery calls, conversion rates, patient visits, average visit revenue, and recurring revenue.

Financial statements also help you understand expenses, profitability, and cash flow.

Over time, those numbers reveal patterns.

And those patterns can show you where the biggest opportunities for improvement exist.

The more consistently you track meaningful information, the easier it becomes to identify your clinic's current constraint and determine what to work on next.

How Michele Built a Team That Doesn't Depend on Her for Every Patient

Summit's growth hasn't come exclusively from adding new services.

Michele has also built a team that allows the practice to operate without requiring her to treat patients full-time.

At the time of the interview, Summit had three full-time clinicians in addition to Michele.

The clinic also employed a full-time clinic coordinator who managed much of the day-to-day administrative work.

Michele was treating approximately four to six hours per week.

She also continued providing bike fittings, a service she particularly enjoyed.

That allowed her to maintain some direct patient interaction while dedicating more time to running the business.

It's a significant change from the early days when she was personally responsible for nearly everything.

And it's an important milestone for any clinic owner who wants greater time freedom.

At some point, growing a practice requires shifting your attention from delivering every service yourself to developing the people and systems that allow the business to operate.

That doesn't mean you have to stop treating patients.

Michele still enjoys clinical work.

But she has the flexibility to decide how much of it she wants to do.

Delegating Discovery Calls Without Sacrificing Conversions

One of the most interesting examples of delegation came when Michele hired her clinic coordinator.

Shortly after the coordinator started, Michele had a two-week ski trip planned.

That created a problem.

Michele was still responsible for many of the clinic's discovery calls.

If she wasn't available, potential patients might have to wait.

Rather than allowing those opportunities to disappear, Michele trained her coordinator to handle the calls while she was away.

The initial expectations were modest.

Michele understood that her coordinator was still learning.

Even if she converted fewer leads than Michele normally would, the clinic would still be better off than leaving calls unanswered.

But something unexpected happened.

The coordinator performed extremely well.

Michele recalled that her conversion rate during that period was around 80%, potentially higher than Michele's own rate.

That changed the conversation.

Instead of immediately taking all the discovery calls back, Michele recognized that her coordinator was capable of continuing the responsibility.

The clinic also began allowing the coordinator to handle people who called directly rather than requiring them to schedule another conversation.

That eliminated an unnecessary step in the patient acquisition process.

It's a practical example of how delegation can improve operations.

Sometimes the owner is holding onto a responsibility because they've always done it.

But another team member may be equally capable, or even better suited, to handle it.

You don't discover that until you give them the opportunity.

Letting Clinicians Take Ownership of Their Interests

Michele applies the same philosophy to responsibilities beyond patient care.

Rather than assigning every additional task herself, she looks for opportunities that align with her clinicians' interests.

One clinician particularly enjoys education.

Summit holds a weekly one-hour clinician meeting where the team discusses challenging patient cases and works on professional development.

Michele previously led those meetings.

Now that clinician has taken ownership of them.

It's a small but meaningful leadership responsibility.

Another clinician enjoys marketing.

She helps manage the clinic's Instagram presence and participates in planning community events.

Those responsibilities give team members opportunities to contribute beyond their treatment schedules.

They also reduce the number of decisions and tasks that depend entirely on Michele.

This approach creates a more sustainable leadership structure.

Instead of trying to make every clinician fit the same role, Michele identifies what people enjoy and looks for ways to incorporate those strengths into the business.

That can improve engagement, professional development, and retention.

And it allows the owner to focus on responsibilities that have the greatest impact on the business.

Why Community Marketing Still Drives Summit's Growth

Although Summit has expanded its use of paid advertising, Michele hasn't abandoned the grassroots marketing strategies that helped establish the clinic.

The team continues participating in local events.

They provide injury screens.

They host workshops.

And they attend races and other community activities.

Those efforts are particularly valuable in a market like Stowe, where outdoor recreation is a major part of the local culture.

Michele wants people to recognize Summit PT and Performance as an active member of the community.

One of her favorite things to hear from potential patients is that they've seen the clinic everywhere.

That recognition doesn't happen overnight.

It comes from consistently showing up.

And it reinforces the clinic's reputation among the people most likely to benefit from its services.

Summit also benefits from strong word-of-mouth referrals.

Patients recommend clinicians to friends and family because they've had positive experiences.

Michele credits the quality of her team as one of the biggest contributors to the clinic's growth.

She also shared that approximately 35% of visits were performance or continuity visits.

That means a meaningful portion of the clinic's activity comes from people continuing their relationship with Summit beyond traditional rehabilitation.

Combined with community visibility and patient referrals, those ongoing services help create a business that isn't dependent on a single marketing channel.

Creating a Business That Supports Life Outside the Clinic

One of the most important themes in Michele's story is that business growth hasn't eliminated her desire for flexibility.

She enjoys skiing.

She loves mountain biking.

And she values spending time with friends and family.

Those priorities have remained important throughout the process of building Summit.

Her weekly schedule reflects that.

Michele typically works from home on Mondays and Fridays.

She spends portions of Tuesday, Wednesday, and Thursday at the clinic, including time for meetings, patient care, and bike fittings.

Working from home allows her to focus on tasks that require uninterrupted attention.

When she's physically at the clinic, she enjoys interacting with patients and clinicians.

She likes being part of the environment she's created.

But she also recognizes that those conversations can make it difficult to complete focused administrative work.

Having flexibility in where she works helps her manage both responsibilities.

And when the weather is particularly good, she may adjust her schedule to get outside during the day.

That doesn't mean she never works evenings.

Michele acknowledges that she still occasionally finds herself working at eight or nine o'clock at night.

But she has more control over when and how she completes her work.

That flexibility is one of the benefits she's built through practice ownership.

The Impact of Building Something Bigger Than Yourself

Michele recently celebrated Summit PT and Performance's fifth anniversary.

The clinic hosted a celebration with a food truck and invited current and former patients.

For Michele, one of the most meaningful parts of the event was meeting people she didn't personally know.

In the early days, she knew every patient.

She scheduled the appointments.

She delivered the treatment.

And she managed nearly every part of the patient experience.

Now the clinic has grown to the point where patients may interact with other clinicians and staff members without ever meeting Michele.

At the anniversary celebration, she heard stories from people whose lives had been improved through the work of her team.

That experience helped reinforce something important.

The impact of the business had grown beyond what Michele could accomplish as an individual clinician.

She had created an environment where other physical therapists could do meaningful work.

And those clinicians were helping people return to the activities they loved.

For many practice owners, that's one of the most rewarding parts of scaling.

You're no longer limited by the number of patients you can personally treat.

You can build a team that helps more people while creating rewarding career opportunities for other clinicians.

What Michele Would Tell a PT Thinking About Starting a Practice

When Courtney asked Michele what she would do differently if she could start Summit again, her answer was surprisingly simple.

She didn't have any major regrets.

She would still want to hire the same clinicians.

She would still want to build the same relationships.

And she recognized that much of what she learned came from working through the challenges of ownership.

Her advice reflects a familiar PT Biz concept: your first attempt at something probably won't be perfect.

That's normal.

Whether you're developing an onboarding process, launching a new service, or creating a marketing campaign, improvement comes through repetition.

You start.

You learn what works.

You make adjustments.

And you continue refining the process.

Michele also emphasized the value of having a community of other practice owners.

Friends and family can be incredibly supportive, but they don't always understand the specific challenges of running a cash-based PT clinic.

Having access to people who are dealing with similar hiring, marketing, financial, and leadership decisions provides a different level of support.

For Michele, being part of the PT Biz community has been an important part of her experience.

And for clinicians considering starting their own practices, her advice is to pursue the opportunity and find the support needed to navigate it.

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If you're considering starting your own cash-based physical therapy practice, check out the free PT Biz Part-Time to Full-Time 5-Day Challenge.

You'll learn how to determine your income replacement goal, calculate the patient volume and pricing needed to replace your income, and create a practical plan for transitioning into full-time practice ownership.

Already running a clinic and looking for your next growth opportunity?

Visit Physical Therapy Biz to take the free Clinic Growth Blueprint Assessment and receive a customized 90-day growth plan.

You can also explore additional episodes of the PT Entrepreneur Podcast.

To learn more about Michele's practice, visit Summit PT and Performance or follow Summit on Instagram.

Final Thoughts

Michele Mannino didn't start her career with the goal of building a successful cash-based physical therapy clinic.

She studied business, worked in sports marketing, became a personal trainer, earned her PT degree, and eventually developed a bookkeeping business.

Practice ownership wasn't part of the original plan.

But once she recognized the opportunity to build something that aligned with her interests, she took action.

Five years later, Summit PT and Performance has grown into a multi-clinician practice with specialized services, small group training, strong community relationships, and a team that allows Michele to spend more time leading the business.

Her story highlights several important lessons.

You don't need a perfect facility to start.

You don't need to personally provide every service your clinic offers.

And you don't need to sacrifice everything outside of work to build a growing business.

What matters is developing strong relationships, understanding your numbers, hiring people who share your values, and creating services that genuinely benefit your patients.

The goal isn't simply to build a clinic that generates more revenue. It's to build a business that creates meaningful opportunities for your patients, your team, and your own life.

And sometimes the best way to get there is to start with a folding treatment table, a few patients, and a willingness to figure things out as you go.