Provider Demographics
NPI:1982249876
Name:POMEROY, BREIANN ELESE (MS, AT, ATC)
Entity type:Individual
Prefix:
First Name:BREIANN
Middle Name:ELESE
Last Name:POMEROY
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:BREIANN
Other - Middle Name:ELESE
Other - Last Name:RICHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:5602W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-9172
Mailing Address - Country:US
Mailing Address - Phone:906-286-2240
Mailing Address - Fax:
Practice Address - Street 1:5602W RIVER RD
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-9172
Practice Address - Country:US
Practice Address - Phone:906-286-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2540392255A2300X
390200000X
MI26010030102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program