Logan Deros

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15056 Issued in CT

Practice address

775 Main St S Unit 70
Southbury, CT 06488-2271

Phone

(203) 437-6155

NPI assigned

Aug 7, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anb-Ptsma Holdings IncGroup PAC ID 4789572926, 190 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Anb-Ptsma Holdings, Inc.

  dba Physical Therapy & Sports Medicine Centers

  • Physical Therapist
  • West Hartford, CT
  • NPI 1659453371
  Medicare reassignment Care Compare group NPD
• Sacred Heart University, Inc

  dba Sacred Heart University Physical Therapy Specialists

  • Physical Therapist
  • Fairfield, CT
  • NPI 1154678928
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1881579043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 N MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061071926",
            "telephone_number": "860-409-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 MAIN ST S UNIT 70",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882271",
            "telephone_number": "203-437-6155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROS",
        "first_name": "LOGAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-07",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "15056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annmarie Delessio-Matta, D.M.D.
• Rhea Caitlin Dell'Orletta, OTR/L
• Odin Delos Reyes, D.P.M
• Christopher Edward Dembski, D.C.
• Saldy John Delariarte Deocampo, P.T
• Emily Terese Diaferio, OTR/L
• Diagnostic Imaging of Southbury
• Stephen Charles Dibenedetto, D.D.S.
• Jennifer Didonato, LPC
• Jenelle Digianvittorio, APRN

• Physical Therapist in Southbury, CT
• Providers in Southbury, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.