| Doctor Name: | SONRIE GERVACIO PICKENS |
| NPI Number: | 1629203880 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | |
| Business Practice Address: | 4102 Pinion Dr Usaf Academy, CO - 808402502 |
| Business Phone Number: | 7193333107 |
| Business Fax Number: | |
| Mailing Address: | 4102 Pinion Dr, USAF ACADEMY |
| State: | CO |
| Postal Code: | 808402502 |
| Phone Number: | 7193333107 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2009 |
| NPI Last Update Date: | 06/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |