Healthcare Provider Details

I. General information

NPI: 1982249876
Provider Name (Legal Business Name): BREIANN ELESE POMEROY MS, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREIANN ELESE RICHEY MS, LAT, ATC

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602W RIVER RD
MANISTIQUE MI
49854-9172
US

IV. Provider business mailing address

5602W RIVER RD
MANISTIQUE MI
49854-9172
US

V. Phone/Fax

Practice location:
  • Phone: 906-286-2240
  • Fax:
Mailing address:
  • Phone: 906-286-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number254039
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601003010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: